Child Abuse and Neglect

What is child abuse and what is child neglect?

Child abuse is defined as any intentional, emotional, physical, or sexual injury to a child.

Child neglect is the most prevalent kind of abuse and can be either physical, emotional, or educational. Child neglect can be intentional or unintentional.

What are some of the behaviors associated with abuse and what injuries do they cause a child?

Physical abuse:

  • Bruises, such as those caused by hands, fists, electrical cords, clothes hangers, and belts;
  • Internal organ injury which can be difficult to detect but may lead to internal bleeding;
  • Bone fractures, especially arms, legs, and skull;
  • Burns from such things as cigarettes, lighters, and stove burners;
  • Lacerations caused by knives, razor blades, or other sharp objects.

Sexual abuse:

  • Inappropriate sexual touching;
  • Fondling;
  • Rape;
  • Prostitution;
  • Pornography;
  • Sexual abuse of a child includes forcing the child to perform or help to perform any sexual behavior.

Emotional abuse:

  • Ridicule;
  • Belittling.

Neglect:

  • Physical neglect involves a spectrum of behavior. It ranges from refusing to provide basic nutrition or necessary health care for the child to total abandonment of the child.
  • Emotional neglect has a wide spectrum of behavior starting with the absence of adequate adult affection toward the child. It includes exposing the child to physical violence and/or arguing/fighting between parents.
  • Educational neglect occurs when the child’s caretakers fail to provide the child with an adequate educational experience.

What are some of the statistics associated with child abuse and neglect?

Neglect is the most prevalent form of abuse. Physical abuse is the second most prevalent form followed by sexual abuse.

About 5 percent of children in the United States are thought to be victims of some form of reported abuse.

According to child abuse surveys, more than 3,000,000 children are reported to child protective services in the United States each year. That means that there are more than 8,000 people every day who are reported to authorities for allegedly abusing a child.

Between 1000 and 1500 children die of abuse and/or neglect in the United States every year.

What leads to child abuse or neglect?

Ignorance can often cause parents or caregivers to neglect a child. For instance, parents who don’t understand the special needs of their children or who themselves have not grown up in nurturing environments are more likely to neglect a child by failing to give the child adequate nurturing or important emotional support.

Severe stress can lead an adult to abuse a child. Young, single parents without sufficient emotional support for themselves are more vulnerable to neglect and abuse their children.

Sexual abuse of a child often starts with inappropriate touching or fondling. If the abuse is not stopped, the perpetrator may proceed to full sexual intercourse with the child. (Perpetrators cannot usually stop themselves. Someone else must usually intervene on behalf of the child.)

Do men or women abuse or neglect children?

Both men and women can be neglectful or abusive toward children.

At what age are children abused?

Physical, emotional, or sexual abuse can begin in infancy and may continue through adolescence. Young children between the ages of 3-5 are frequently the victims of molestation or incest because they are not old enough to describe in accurate detail what happened to them or when.

How is child abuse discovered or diagnosed?

Abuse can be difficult to detect and diagnose. Abuse of a child is usually reported by someone other than the child’s parents. Relatives, neighbors, child care workers, school authorities, or health care providers may become suspicious that a child is being abused and call the authorities. Anyone can report suspected child abuse: teachers, counselors and medical personnel are obligated to report suspected abuse to child protective services. Because abusive adults often threaten their victims, the victim may fear telling anyone, and, therefore, the abuse may continue over a long period of time. Many adults have never talked about the abuse they received as a child. However, today, children are often taught by their parents, other caregivers, and teachers to report any inappropriate adult behavior.

How is child abuse treated?

The most important aspect in treating the child who is physically or sexually abused is to make sure that the child is safe. To insure safety, the child may have to be removed from his/her abusive family. In order to help the child heal from his/her trauma, the child should receive psychotherapy. Therapy helps abused children rebuild their self-esteem, reduce their fears, and regain a trusting relationship with an adult. Parents are almost always strongly encouraged to be involved in the child’s therapy.

What happens to children who have been abused?

With proper psychological treatment, children can heal from abuse. However, many children never receive adequate treatment, and these children can carry the scars of abuse into their adult lives. Many adults who were abused as children have never dealt with this trauma in their own lives and, therefore, may themselves become abusive toward their children. Thus, the cycle can repeat itself. Children who have been abused often suffer from Post-traumatic Stress Disorder, Depression and/or Anxiety, drug/alcohol abuse, and difficulty forming satisfactory relationships when they reach adulthood.

What can people do if they need help?

If you, a friend, or a family member would like help, ask your therapist, family doctor, or call your county Children’s Services Department. There are support groups for adults molested when they were children.

Julie Woltil,PhD specializes in treating adults that have abused children.

Tanna Hoagland,PhD specializes in helping women who have been victims of violence or abuse.

David Britton specializes in treating Post-traumatic Stress Disorder.

Young Children May Begin to Develop Eating Disorders by Watching TV

August 2, 2000
Communication Research/MedscapeWire

Research has shown that most eating disorders begin in adolescence, but a University of Michigan researcher has found that even young grade-school children can develop eating problems — simply by watching television.

“The most straightforward explanation for this finding is that television viewing increases children’s exposure to dieting images, ideas and behaviors, which in turn, lead to changes in their eating-related cognitions and behaviors,” says Kristen Harrison, University of Michigan assistant professor of communication studies.

“Because research on other media effects, such as violence and aggression, suggests that young children are more likely than adolescents or adults to model viewed behaviors, it is reasonable to expect that young children would model the lean body ideal they observe on television. It is also reasonable to expect that television exposure will be correlated with children’s understanding of the thin body as the socially ideal body, and the fat body as the socially stigmatized body.”

In a new study to appear this fall in the journal Communication Research, Harrison surveyed about 300 students, aged 6 to 8 years, at 2 mostly white elementary schools in the Midwest about the amount of television they watch, their favorite television characters, and their beliefs about the ideal body shape and fat stereotyping.

She also measured the students’ disordered eating symptoms by using the Children’s Eating Attitudes Test, an empirical scale containing more than 2 dozen cognitive and behavioral self-report items. Sample items include “I stay away from foods with sugar in them” and “I think a lot about having fat on my body.”

Even after controlling for the fact that some children with eating problems specifically seek out body-related information on television, Harrison found that television viewing, in general, predicts eating disorder symptoms for both boys and girls.

“The fact that the correlation remained suggests that even for children who have little or no interest in fitness and dieting television content, increased television exposure is still linked to increased disordered eating,” she says.

However, while children’s television viewing may indicate the development of eating disorders, Harrison did not find that children necessarily favor thin body-shape standards. This suggests that children may begin modeling the dieting and exercising behaviors they see on television even before they actually begin to internalize the thin-body ideal.

In fact, the girls in the study who watched the most television chose a heavier figure as representing the ideal body size for adult women and a thinner figure as representing their own. This is opposite the pattern one might expect, in which television viewing would predict the overestimation of one’s own body size and the choice of unrealistically thin standards for the ideal size of females in general, Harrison says.

“Girls who were interpersonally attracted to average-weight female characters reported the healthiest (or normal) body-size choices and believed thinness to be relatively unimportant,” she says. “This suggests that adopting normal-weight role models on television could be beneficial for girls.”

In contrast, those girls attracted to thin female television characters are more likely to view their own bodies as heavier, while boys attracted to thin male characters favor a thinner ideal-body size for males, the study shows.

In addition, television viewing, in general, predicts an increased tendency among boys to negatively stereotype a heavy girl (but not a heavy boy) — a finding that Harrison says is not surprising since prior research has shown this. She adds that the media may teach young children, and boys in particular, to “denigrate fatness before they learn to idealize thinness.”

“Children’s interpersonal attraction to television characters appears to play an important role in the outcomes of television exposure vis-à-vis fat stereotyping and body-shape standards, although this role is more complicated than I had initially predicted,” Harrison says.

For example, she found that attraction to heavy male characters is associated with decreased “fat-boy” stereotyping among both boys and girls, but attraction to fat female characters is not linked to less “fat-girl” stereotyping.

Further, Harrison says, girls’ attraction to average-weight female characters decreases their risk of developing thinness-favoring cognitions and behaviors, but for boys, attraction to average-weight male characters predicts increased eating disorder symptoms.

“It is clear that we need more research to clarify the relationships between children’s interpersonal attraction to characters of varying body types and their eating- and body-related cognitions and behaviors,” Harrison says. “Only through increased understanding of how children of varying ages and both sexes may develop damaging body standards through early-life media exposure can we increase our understanding of how interventions, especially media-based interventions, may be adapted to a child audience to minimize their risk of developing eating disorders in adolescence and beyond.”

Tanna Hoagland,PhD specializes in working with children and adults with body image issues.

Positive Psychology Halved Depression in Kids

Clinical Psychiatry News

BETHESDA, MD. — Positive psychology techniques that aim to instill a sense of optimism halved the rate of depression in three studies of young adults and children that included as much as 10 years of follow-up, Martin Seligman, PhD, said at a meeting on preventing depression sponsored by the National Institutes of Health.

The goal of positive psychology is to enhance basic human strengths such as optimism, courage, honesty, self-understanding, and interpersonal skills, instead of focusing on “the broken things” and on repairing the damage of past traumas, said Dr. Seligman, professor of psychology at the University of Pennsylvania in Philadelphia. Positive psychology is meant to help the individual use inner resources as a buffer against setbacks in life and as a means to master adversity whenever it crops up, so that he or she does not sink into depression, he said. “It’s not about how to heal; it’s about how to have a great life,” explained Dr. Seligman, who also is immediate past president of the American Psychological Association.

He and his associates developed an intervention that was designed to instill a sense of optimism, which they defined as a positive way of construing the failures and setbacks that normally occur in life. “If you think that failures are stable and pervasive — that they’ll last forever and undermine everything you try to do — you’ll get depressed. But if you can view them as temporary or affecting only a small part of your life, you won’t get depressed,” Dr. Seligman explained.

In a research project involving university students, Psychologists screened students using a questionnaire that measured the students’ optimism. The students who scored the lowest for optimism were then randomly assigned either to no intervention or to a workshop that was designed to develop skills to boost their optimism. Principal among the skills taught in the workshop was the cognitive therapy approach known as “disputing.” The students were taught to recognize their own negative thoughts about themselves and to argue against these thoughts as though they were disputing an external critic, Dr. Seligman said.

The 126 subjects who took part in the workshops and the 119 controls were then followed up for 8-10 years. During young adulthood, those who had participated in the positive psychology program when they were in college were half as likely to have episodes of moderate unipolar depression (13%) as were the control subjects (27%). Similarly, the subjects who had taken part in the workshops had half the rate of generalized anxiety disorders, compared with the controls, he said.

Dr. Seligman and his associates then studied 10- to 12-year-old children who had symptoms of mild depression. In this study, 67 children participated in a similar positive psychology intervention and 47 served as controls. After 2 years of follow-up, the rate of mild to moderate depression was twice as high among the controls (44%) as among the children who had participated in the intervention (22%).

In a third study, University of Pennsylvania researcher Dr. David Yu reported similar results after 3 months of follow-up of 10- to 12-year-olds in Beijing. He studied 104 children who underwent a positive intervention and 116 children who served as controls, he said.

Michael Sherman specializes in teaching Positive Psychology skills to adults and children.

Nightmare Remedies: Helping Your Child Tame the Demons of the Night

by Alan Siegel, Ph.D.

Our children do not have to suffer their nightmares in silence, brooding about the lingering feeling of suffocation left by the formless ghost or shuddering at the memory of the razor-sharp teeth of a pack of wolves ripping into their flesh. There are remedies for even the most dreadful nightmares.

Unfortunately, the raw terror that lingers after a nightmare may accentuate a child’s insecurity and bring on anxiety for hours or even days afterward. It may even disturb their ability to sleep by inducing insomnia, or fears and phobias about sleeping and dreaming. To help your child restore their capacity to sleep and to harness the healing and creative potential of scary dreams, we must help them break the spell of their nightmares.

The silver lining of painful nightmares is that they shine a spotlight on the issues that are the most upsetting for your child. Every nightmare, no matter how distressing, contains vital information about crucial emotional challenges in your child’s life. To a parent whose ears and heart are open, listening to the most distressing nightmares is like hearing your child’s unconscious, speaking directly to you delivering a special call for help.

Most nightmares are a normal part of coping with changes in our lives. They are not necessarily a sign of pathology and may even be a positive indication that we are actively coping with a new challenge. For children, this could occur in response to such events as entering school, moving to a new neighborhood or living through a divorce or remarriage.

Using role-playing and fantasy rehearsals, parents can coach their children to assert their magical powers and tame the frights of the night. New endings for dreams can be created so that falling dreams become floating dreams and chase dreams end with the capture of the villain. When we give our children reassurance and encouragement to explore creative solutions to dream dilemmas, we restore their ability to play with the images in their nightmares rather than feeling threatened or demoralized. These assertiveness skills carry over into future dream confrontations and lead to greater confidence to face waking challenges.

CHILDREN’S NIGHTMARES

Children suffer more frequent nightmares than their parents and, prior to the age of six, nightmares are especially common. Nightmares diminish as children grow older, master their fears, and gain more control over their world.
Most nightmares are a normal part of coping with changes in our lives. They are not necessarily a sign of pathology and may even be a positive indication that we are actively coping with a new challenge. For children, this could occur in response to such events as entering school, moving to a new neighborhood or living through a divorce or remarriage.

A good working assumption is that many nightmares in children are reactions to upsetting events, situations and relationships. It is important to keep in mind that often a stress such as moving to a new neighborhood will be complicated by a chain reaction of other changes. Nightmares will usually diminish in intensity and frequency as the child and the family recover and cope with stresses such as a death in the family or birth of a new family member.

RECURRING NIGHTMARES

Anyone who keeps track of their dreams and nightmares will begin to notice recurring symbols and patterns. Studies of people who have kept dream journals for as long as 50 years have shown that certain animals or houses or people who appear in a person’s childhood or teenage dreams will still turn up when their hair is gray. Your own personal repertoire of nightmare symbols may emerge early in childhood, evolving and transforming throughout your life span. Repeating dream patterns may also be influenced by disturbing images from television and film, family fears, cultural stereotypes, myths, and religious beliefs and stories.

What can we learn from recurrent dreams? They are often a warning of lingering psychological conflicts. For example, children of divorce frequently dream that their parents have reunited; abuse survivors are often victims or perpetrators of violence in their dreams; and adopted children intermittently dream of their birth parents.

Conversely, changes within recurring dreams may signal the onset of resolving a psychological impasse. For example, a survivor of child abuse who was making a therapeutic breakthrough in her emotional recovery dreamed of triumphing over a shadowy, hostile figure that had threatened and chased her in innumerable prior nightmares.

STAGES OF RESOLUTION IN RECURRING DREAMS

Three stages of resolution can be identified in children’s nightmares.

  • Threat: In the dream, a main character is threatened and unable to mount any defense. For example, he or she may be paralyzed while trying to flee the jaws of a hungry ghost imprisoned by aliens.
  • Struggle: Attempts to confront the nightmare adversary are partially successful in fending off danger. An example would be temporarily escaping a robber with a knife and trying to dial the phone for help.
  • Resolution: The nightmare enemy, opponent, or oppressor is vanquished and the threatening creatures are put in cages, slain, or held at bay with magic wands, or otherwise disarmed.

In some cases, children spontaneously resolve a recurring nightmare as the formerly distressing situations, which caused the nightmares, get worked out in the child’s real life.

The Four R’s That Spell Nightmare Relief

There are many potentially beneficial nightmare remedies that parents, family members, and even siblings can use to help a child break the spell of a disturbing nightmare and transform terror into creative breakthroughs. In order to soothe the lingering terror and banish the demons of the night, you must learn the Four R’s that spell nightmare relief for your children. They are

REASSURANCE, RESCRIPTING, REHEARSAL AND RESOLUTION.

Reassurance is the first and most important dimension of remedying children’s nightmares. This includes “welcoming the dream” with special emphasis on physical and emotional reassurance, which will calm your child’s anxiety and help them feel safe enough to give details about the nightmare and be open to further exploration.

Everyone has nightmares and no one has to bear the pain without help. Reassurance quells the post-nightmare jitters and allows you and your child an opportunity to discover both the creative possibilities and the source of what sparked the nightmare that may still be disturbing your child.

Rescripting means inviting and guiding your child to imagine changes in the outcome of their dream by reenacting or rewriting the plot. Even with young children, rescripting is most effective when it is a collaborative process of brainstorming together. The most well known form of rescripting is creating one or more new endings for a dream using art work, fantasy, drama, and writing.

Rescripting2, is like assertiveness training for the imagination. Ominous dream monsters, demons, and werewolves can be tricked and trapped, tamed and leashed, given time-outs, bossed around, and generally made less intimidating. With parental assistance, the child with nightmares can be taught to revolt and throw off the yoke of dream oppression by using magical means such as fairy dust, a wizard’s wand, Star Trek™ “Phasers,” special incantations and spells, or other handy tools of the imagination. Very often developing and rehearsing solutions to dream dilemmas carries over to increased confidence in facing waking conflicts.

One of the most enjoyable aspects of resolving nightmares is helping your child create their own repertoire of “Magical Tools” for dream assertiveness. These tools are limited only by your imagination and can be inspired by your child’s interests, current movies or television shows, your families cultural background, books or projects they are completing for school, and so on.

Even chronic nightmare sufferers, both adults and children, have found relief from relatively simple treatments and techniques. Vietnam veterans with persistent nightmares have been successfully treated with psychotherapy approaches that focus on resolving both the dreams and the unresolved traumas that caused the dreams to continue.

There are a few areas of caution that should be considered with respect to rescripting. The first is the use of violence in fantasy solutions to bad dreams. Killing the nightmare adversary may not be the optimal solution even in imaginary battles. Ann Sayre Wiseman, author of Nightmare Help warns that suggesting the murder or destruction of a dream foe may subtly encourage violent solutions to life problems and reinforce a tendency that children are already overexposed to through television, movies, news and violence in our society. On the other hand, encouraging creative, nonviolent, assertion in working out dream battles, may lead to improved and more constructive waking problem-solving skills.

The second caution is about the limits of creating new endings for nightmares. There is a misconception that using fantasy and magical tools to create a new dream ending assures that the underlying problem that stimulated the dream has been resolved. This may not be the case. While impressive results have been obtained using rescripting to reduce the frequency and intensity of nightmares, we must remember that nightmares, especially recurring ones, are messages–even warnings–from within that we are overwhelmed by a new situation, crisis, or chronic conflict such as a custody dispute or marital conflict. When there is a persistent problem in a child’s life, we may need to go beyond reassurance and rescripting to discover fundamental solutions to the life problems that set off the dream. This leads us to the two final R’s – rehearsal and resolution.

Rehearsal is practicing solutions to a nightmare’s various threats. Going a step beyond the new endings or magical tools used in rescripting a nightmare, rehearsal involves repeating the dream and its solutions in various forms until a sense of mastery or accomplishment has been achieved. This stage parallels the stage of psychotherapy called “working through,” where for adults, the insights they have gained need to be put to the test–at first in the relationship with their therapist and gradually by practicing new forms of relating with others and experiencing themselves in new ways.

Resolution is the final stage of alleviating the haunting spell of a nightmare. Discovering the source of the nightmare in your child’s life and working towards acknowledging and even correcting the life problem that has caused the nightmares are preliminary steps. Resolution can only come after a child feels secure enough (reassurance) to explore new solutions through art, writing, drama, and discussion (rescripting) and has practiced those solutions (rehearsal) with a parent or adult guide.

If a child continues to be curious about what is emerging from his or her exploration of a dream, they can be encouraged to honor their dream by connecting it to a person, situation, or feeling in their current life. By keeping in mind the major emotional issues affecting your child such, as the birth of a sibling or starting at a new school, parents can be alerted to the probable sources of a nightmare.

Through the process of exploring, brainstorming, and rehearsing metaphoric solutions to their children’s nightmares, parents begin to feel more secure in linking dream symbols to the current events and relationships in their child’s waking world. Nightmares emphasize to parents exactly what is most difficult for their child and open up possibilities for resolving important emotional challenges.

WHEN TO SEEK HELP FOR NIGHTMARES

Whereas moderate nightmare activity may be a potentially healthy sign that the unconscious mind is actively coping with stress and change, frequent nightmares indicate unresolved conflicts that are overwhelming your child. When children’s nightmares persist, when their content is consistently violent or disturbing, and when the upsetting conflicts in the dreams never seem to change or even achieve partial resolution, it may be time to seek further help from a mental health specialist or pediatrician. Especially if there is no obvious stress in your child’s life, repetitive nightmares could also be caused by a reaction to drugs or a physical condition, so it is advisable to consult a physician to rule out medical causes when nightmares do not appear to have a psychological origin.

Repetitive nightmares are often accompanied by other symptoms especially fears of going to sleep, anxieties or phobias. Increased nightmares can usually be linked to a recognizable stress in the child’s life such as absence or loss of a parent, suffering abuse or violence, marital or custody disputes in the family, social or academic difficulties at school, such as being teased or having an undiagnosed learning or attention problem.

Sleep Problems in Children

Sleep problems are very common among children during the first few years of life. Problems may include a reluctance to go to sleep, waking up in the middle of the night, nightmares, and sleepwalking. In older children, bed-wetting can also become a challenge.

Children vary in the amount of sleep they need and the amount of time it takes to fall asleep. How easily they wake up and how quickly they can resettle are also different for each child. It is important, however, that as a parent you help your child develop good sleep habits at an early age. The good news is that most sleep problems can be solved.

Infants

Newborn infants have irregular sleep cycles which take about 6 months to mature. While newborns sleep an average of 16 to 17 hours per day, they may only sleep 1 or 2 hours at a time. As children get older, the total number of hours they need for sleep decreases. However, different children have different needs. It is normal for even a 6 month old to wake up briefly during the night, but these awakenings should only last a few minutes and children should be able to go back to sleep easily on their own. Here are some suggestions that may help your baby (and you) sleep better at night:

1. Try to keep him/her as calm and quiet as possible. When feeding or changing your baby during the night, avoid stimulating him/her too much.

2. Don’t let your infant sleep as long during the day.

3. Put your baby into the crib at the first signs of drowsiness. Ideally it is best to let the baby learn to relax herself to sleep. If you make a habit of holding or rocking him/her until they fall asleep, h/she may learn to need you to get back to sleep when h/she wakes up in the middle of the night.

4. Avoid putting your baby to bed with a pacifier. Your baby may get used to falling asleep with it and have trouble learning to fall asleep without it. Pacifiers should be used to satisfy the baby’s need to suck, not help a baby sleep.

5. Begin to delay your reaction to infant fussing at 4 to 6 months of age. Wait a few minutes before you go in to check a crying baby.  They will probably settle themselves and fall back to sleep in a few minutes anyway. If baby continues to cry, check on him/her, but avoid turning on the light, playing, picking up, or rocking them. If crying continues or begins to sound frantic, wait a few more minutes and then recheck the baby. Once your baby realizes that you are not going to run in and comfort them, they will begin to fuss less and simply return to sleep. This is an important time for new parents to support each other in learning to be patient.

Toddlers and preschoolers

Many parents find their toddler’s bedtime one of the hardest parts of the day. It is common for children this age to resist going to sleep, especially if there are older siblings who are still awake. Remember toddlers and preschoolers usually need 10 to 12 hours of sleep each night.

Following are some tips to help your toddler develop good sleep habits:

1. Make sure there is a quiet period before your child goes to bed. Establishing a pleasant routine that may include reading, singing, or a warm bath. A regular routine will help your child understand that it will soon be time to go to sleep. If parents work late hours, it may be tempting to play with their child before bedtime. However, active play just before bedtime may leave the child excited and unable to sleep. Limit television viewing and video game play before bed.

2. Try to set a consistent schedule for your child and make bedtime the same time every night. The consistency is important.

3. Allow your child to take a favorite teddy bear, toy, or special blanket to bed each night. Such comforting objects often help children fall asleep–especially if they awaken during the middle of the night.

4. Avoid letting your child sleep with you. This will only make it harder for them to learn to settle down and fall asleep when they are alone.

5. Try not to return to your child’s room every time h/she complains or calls out. A child will quickly learn to take advantage of your “caring” if you always give in to their requests at bedtime. When your child calls out, try the following:

  • Wait several seconds before answering. Your response time can be longer each time to give your child the message that it is time for sleep. It also gives him the opportunity to fall asleep on his own.
  • Reassure your child that you are there. If you need to go into their room, do not stimulate the child or stay too long.
  • Move farther from your child’s bed every time you reassure them, until you can do this verbally without entering the room.

Common sleep problems

For a young child, many things can interrupt a good night’s sleep. As a parent, you may be able to prevent some of them.

Nightmares

Nightmares are scary dreams that usually happen during the second half of the night, when dreaming is most intense. This may occur more than once a night. After the nightmare is over, your child may wake up and can tell you what occurred. Children may be crying or fearful after a nightmare but will be aware of your presence. They may have trouble falling back to sleep because they can remember the details of the dream.

How to handle nightmares:

  • Go to the child as quickly as possible.
  • Assure your child that you are there and will not let anything harm them. Comfort and calm them.
  • Allow the child to have a night light on.
  • Keep in mind that a nightmare is real to a young child. Listen to them and encourage them to tell you what happened in the dream.
  • Empower your child by giving them a “magic” wand, dream catcher, or something similar they can put under their pillow or near their bed.

Night terrors

Night terrors are more severe or frightening than nightmares, but not as common. They occur most often in toddlers and preschoolers. Night terrors occur during the deepest stages of sleep, usually within an hour or so after a child falls asleep. During a night terror, children usually cannot be awakened or comforted. Night terrors may also cause the following:

  • Uncontrollable crying
  • Sweating, shaking, and fast breathing
  • A terrified, confused, and glassy-eyed appearance
  • Thrashing around, screaming, kicking, or staring
  • Child may not realize anyone is with him
  • Child may not appear to recognize you
  • Child may try to push you away, especially when you try to restrain him

Night terrors may last for as long as 45 minutes, but are usually much shorter. Children seem to fall right back to sleep after a night terror, but they actually have not been awake. Like nightmares, night terrors may occur more often in times of stress or may relate to difficult feelings or fears. However, unlike a nightmare, a child does not remember a night terror.

How to handle night terrors:

  • Remain calm. Night terrors are usually more frightening for the parent than for the child.
  • Do not try to wake your child.
  • Make sure the child does not injure them self. If the child tries to get out of bed, gently restrain them.
  • Remember, after a short time, your child will probably relax and sleep quietly again.
  • If your child has night terrors, be sure to explain to your baby-sitters what they are and what to do.

Keep in mind that night terrors do not always indicate serious problems. Your child will be more likely to have night terrors when they are overly tired and during periods of stress. Try to keep your child on a regular sleep schedule or increase the amount of sleep to prevent night terrors. Night terrors usually disappear by the time a child reaches grade school.

Sleepwalking and sleep talking

Like night terrors, sleepwalking and sleep talking happen when a child is in a deep sleep. While sleepwalking, your child may have a blank, staring face. They may not respond to others and be very difficult to awaken. When your child does wake up, they will probably not remember the episode. Sleepwalking children will often return to bed by themselves and will not even remember that they have gotten out of bed. Sleepwalking can be common, and tends to run in families. It can even occur several times in one night among older children and teenagers.

How to handle sleepwalking and sleep talking:

  • Make sure your child doesn’t hurt them self while sleepwalking. Clear the bedroom area of potential hazards that your child could trip over or fall on.
  • Lock outside doors so your child cannot leave the house.
  • Block stairways so your child cannot go up or down.
  • There is no need to try to wake your child when they are sleepwalking or sleep talking. Gently lead them back to bed and they will probably settle down on their own.

Sleepwalking and sleep talking are more likely to occur when your child is overly tired or under stress. Keeping your child’s sleep schedule regular may help prevent sleepwalking and sleep talking.

Bed-wetting (also called enuresis)

Nighttime bed-wetting is normal and very common among preschoolers. It affects about 40% of 3 year olds and may run in families. The most common reasons your child may wet the bed include the following:

  • A bladder that has not yet developed enough to hold urine for a full night.
  • Your child may not yet be able to recognize a full bladder and wake up to use the toilet.
  • Stress. Changes in the home, such as a new baby, moving, or a divorce can lead to a sudden case of bedwetting for a child who has been dry at night in the past.

How to handle bed-wetting:

  • Do not blame or punish the child for bed-wetting.
  •  Avoid drinking large amounts of fluid just before bedtime.
  • Until your child can stay dry during the night, put a rubber or plastic cover over the mattress to protect against wetness and odors. Keep the bedding clean.
  • If your child is old enough, involve them in handling the problem. Encourage them to help change the wet sheets and covers. This will help teach responsibility and avoid the embarrassment of having other family members know about the problem every time it happens. Do not, however, use this as punishment for the child.
  • Children over the age of 7 should practice “stop/start peeing” when they urinate in the bathroom to better develop the bladder muscle that controls the release of urine.

Most importantly, don’t pressure your child. Bed-wetting is usually beyond a child’s control and they may only become sad or frustrated if they cannot stop. Set a “no-teasing” rule in the family. Make sure your child understands that bed-wetting will get better in time.

Teeth grinding

It is also common for children to grind their teeth during the night. Though it produces an unpleasant sound, it is usually not harmful to your young child’s teeth. It may be related to tension and anxiety and usually disappears in a short while.

Give it Time

Handling your child’s sleep problems may be a challenge and it is normal to become upset at times when a child keeps you awake at night. Try to be understanding. A negative response by a parent can sometimes make a sleep problem worse, especially if it is associated with a stressful situation like divorce, a new sibling, a tragedy in the family, problems at school, or some other recent change in your child’s life.

If the problem persists, there may be a physical or emotional reason that your child cannot sleep. Keep in mind that most sleep problems are very common, and with time and your help, your child and you will overcome them.

Treating ADD with Medication

One reason for regarding ADD as a distinct disorder with a biological origin is the immediate and striking relief from some of its symptoms provided by the stimulant drugs methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and magnesium pemoline (Cylert). These drugs are helpful for about 75% of children and adults with ADD. They become less irritable and restless, and their attention and motor coordination improve; others begin to like them better, and they begin to think better of themselves. The drugs have no direct effect on learning disabilities, but may make special education and tutoring easier.

There is little danger of drug abuse or addiction, because users do not feel euphoria or develop tolerance or craving. They become dependent on stimulant drugs, it has been said, only in the same sense that a person with diabetes is dependent on insulin or a nearsighted person on eyeglasses. The main side effects – appetite loss, stomach aches, nervousness, and insomnia – usually subside within a week or can be eliminated by lowering the dose. A child’s rate of growth may be slowed for a few years while he is taking a stimulant, but it returns to normal in adolescence. There is no evidence of long-term deleterious effects.

Methylphenidate and dextroamphetamine are short-acting drugs, but they are now available in time-release capsules that prolong the effects to eight or ten hours. Pemoline is longer-acting. These drugs are started at a low dose that is gradually increased if necessary; parents can make adjustments according to their child’s level of activity. If the symptoms do not improve after two weeks at the highest acceptable dose, drugs will probably never be useful. Some doctors recommend that children take stimulants only during school hours and not on weekends or vacations. Most believe that drug treatment should be discontinued for several weeks once every six months or once a year to see whether it is still needed.

Not a panacea

The long-term benefits of drug treatment are uncertain. It is difficult to predict which children will be helped and how long the drugs will be needed. Anxiety, depression, learning disabilities, and conduct disorders are not directly affected by the drugs. Although children may calm down, concentrate better, and behave less disruptively while taking a stimulant, there is no guarantee that their schoolwork will improve in the long run or that the adult outcome is affected. The original symptoms usually return in full force when a child stops taking the drug.

Adolescents with ADD are often reluctant to take their medications at all. They may be embarrassed about having to see a school nurse at noon to take a pill and humiliated by the implication that they cannot control their own behavior. Adolescents dislike the feeling of being different, defective, or dependent.

Pediatricians and family doctors who consider prescribing stimulants should be sure that the problem is really ADD. Children should not be given drugs just because they are noisy or unruly, and other treatable conditions should be ruled out. Even if drugs are necessary, they should not be used to the exclusion of other treatments or as an excuse for not trying to find and eliminate the causes of specific symptoms in specific circumstances. ADD is not a simple problem with a single solution. Drugs cannot give people skills they have never developed or fully relieve the resulting frustration and shame. Possibly the most important use of drugs is to create a space for other treatments to work.

Getting reassurance

Part of the solution is simply acknowledging that the symptoms constitute a recognized psychiatric disorder. That is often reassuring for children and parents who have found the situation mystifying and maddening. Psychotherapy may help patients to identify and deflect the feelings that cause impulsive and aggressive reactions. Since children with ADD often have difficulty following social rules and understanding social situations, therapy must be didactic; for example, they may have to learn how to look at others who talk to them, listen to what they say, and wait their turn before answering.

Children and adults with ADD need structure and routine. They should be helped to make schedules and break assignments down into small tasks to be performed one at a time. Especially when young, children with ADD often respond well to strict application of clear and consistent rules. In school, they may be helped by close monitoring, quiet study areas, short study periods broken by activity (including permission to leave the classroom occasionally), and brief directions often repeated. They can be taught how to use flashcards, outlines, and underlining. Timed tests should be avoided as much as possible.

In a sense, establishing structure and routine is a form of behavior therapy – consistent schedules with rewards for acceptable behavior. Behavior therapy in a more formal sense is also useful in preventing a particular kind of aggressive or disruptive behavior that occurs in a few specific circumstances, especially in adults, but applying it to all the situations in which symptoms of ADD appear would be impractical – too time-consuming and demanding for anyone’s patience and skill.

Family conflict is one of the most troublesome consequences of ADD. Especially when the symptoms have not yet been recognized and the diagnosis made, parents blame themselves, one another, and the child. As they become angrier and impose more punishment, the child becomes more defiant and alienated, and the parents still less willing to accept their child’s excuses or promises. A father or mother with adult ADD sometimes compounds the problem.

Constantly compared unfavorably with his brothers and sisters, the child with ADD may become the family scapegoat, blamed for everything that goes wrong. When ADD is diagnosed, parents may feel guilty about not understanding the situation sooner, while other children in the family may reject the diagnosis as an excuse for attention-getting misbehavior.

To avoid constant family warfare, parents must learn to distinguish behavior with a biological origin from reactions to the primary symptoms or responses to the reactions of others. They should become familiar with signs indicating imminent loss of self-control by a child with ADD. A routine with consistent rules must be established; these rules can be imposed on young children but must be negotiated with older ones and with adolescents. The family should have a clear division of responsibility, and the parents should present a united front. It often helps to write out complaints and to praise good behavior immediately. Family therapy or counseling, parent groups, and child management training are often useful.

Most of the principles used in treating children with ADD also apply to the treatment of adults. They respond almost as well as children to stimulant drugs (according to one study, even cocaine abusers with ADD can be effectively treated with methylphenidate or dextroamphetamine). Like children, they must often learn how to schedule, organize, and take time to reflect before talking or acting. They may need specialists in learning disabilities or psychotherapists to help them with chronic anger, alcohol and drug abuse, or low self-esteem. Self-help support groups can also be useful. Many suggestions for coping with parent-child conflict apply to conflict between husbands and wives. They have to avoid a pattern in which the person with ADD, constantly criticized and nagged, increasingly ignores or distances his or her partner.

based on The Harvard Mental Health Letter

Keys to Raising a Gifted Child

 Love, laugh, listen, and learn. Raising and nurturing a gifted child can be an exciting yet daunting challenge.

·  Learn to be positive. Giftedness can be an exciting challenge or a chore, depending on how you see a child’s characteristics. For example, persistence and stubbornness are the same trait.

·  Understand the way that your child’s giftedness affects his or her needs: Intellectual, social, emotional, and physical needs. For example, ideas forged by eight-year-old minds may be difficult to produce with five-year-old hands.

·  Be a knowledgeable advocate. The brighter the child is, the greater is his or her emotional complexity and potential vulnerability. You might have to educate the educators.

·  Read aloud to your child. It is important that parents read to their gifted child often, even if the child is already capable of reading.

·  Help your child discover personal interests. Stimulation and support of interests are vital to the development of talents. Parents should expose their child to their own interests and encourage the child to learn about a wide variety of subjects, such as art, nature, music, and sports, in addition to traditional academic subjects such as math, reading, and science.

·  Encourage the support of extended family and friends. As an infant, a gifted child can exhaust new parents because he or she often sleeps less than other babies and requires extra stimulation when awake. (It can be helpful to have extended family in the home, grandparents who live nearby, or close friends in the neighborhood who can spend some time with the child so the primary caretakers can get some rest and to give the infant added — or different — stimulation.)

·  Speak and listen to your child with consideration and respect. From the time he or she can talk, a gifted child is constantly asking questions and will often challenge authority. “Do it because I said so” doesn’t work. Generally, a gifted child will cooperate more with parents who take the time to explain requests than with more authoritarian parents.

·  Teach your child how to find information and resources in a variety of ways. Gifted children need to know, to learn, to solve, and to ponder. There will be times when your child’s expertise on a topic will be greater than yours, and you will not be able to provide answers or solutions.

·  Be a welcome person in your child’s school or educational environment. If educators know you first as a willing volunteer, they will be more responsive when you want something for your child.

·  Become involved in a local, state, or regional parent group. Or join an email list. Parents of gifted children need opportunities to share parenting experiences and problem solving strategies with one another. And it takes the persistence of large groups of parents to ensure that provisions for gifted children are kept firmly in place.

·  The key to raising gifted children is to respect their uniqueness, their opinions and ideas, and their dreams. It can be painful for parents when their children feel out of sync with others, but it is unwise to put too much emphasis on the importance of fitting in; children get enough of that message in the outside world. At home, children need to know that they are appreciated for being themselves.

·  Love, laugh, listen, and learn.

Helping Children Cope with Bereavement

Like adults, children experience similar stages of the grieving process, but can react differently.  This is because they have limited experience with life and find it difficult to express the confused jumble of emotions they feel.

Extremes of behavior are common.  They may at times seem very upset and then totally disinterested in what has happened.  They may want to talk all the time about the person who died, or, not at all.  There may be similar reactions in their attitudes to schoolwork.  Almost inevitably there will be some children who constantly want attention or complain of minor illnesses such as headaches or stomach upsets.

Sometimes these reactions can persist and deepen.  Some children may exhibit a constant and unreasonable anger towards everyone and everything. This may be manifested in shouting or screaming or in physical attacks on siblings or friends.  Sadly, animals are often the victims of a child’s confused state; they can feel that it’s acceptable to take out their anger on a family’s pet or to shoot at birds with a catapult or air gun. An important part of a parent’s responsibility is to teach children more appropriate ways of handling their anger in situations like this.

Depression for children can be a real problem.  They may isolate themselves from all their friends and family, develop an extreme fear of going to school, and/or threaten suicide.  If you feel your child’s behavior goes beyond a normal expression of grief, especially if it lasts more than about six weeks, then consider getting outside help.

HELPFUL CONCEPTS

Of course, there is a great deal that you can do to help your child yourself.  Apart from answering questions as honestly and as fully as you can, you can help by explaining the following concepts:

Death is inevitable:  All living things must die. It’s a natural process. People don’t die because they’ve done, thought or said something wrong and are being punished for it.

Death is irreversible:  It’s important to make sure that the child isn’t suffering the delusion that if they wish the person back enough they will return.  Sometimes young children can be confused by the permanence of death and feel bewilderment, hurt or intense anger when, for example, their parent doesn’t reappear as they used to after a business trip.

Death is for a reason:  Some children find it difficult to accept that illness, accidents or old age are straightforward reasons to die.  It needs to be emphasized that the illness or accident didn’t happen because that person wasn’t ‘good’ enough to live.  Similarly, though it may seem almost callous to even consider it, violent death through murder is a reason to die.  It’s important for children to realize this because they often feel that they caused the death because they thought ‘bad’ things.

Death means that all functions of life cease:  A child’s world is a very sensory one, full of movement and activity.  Some children, who do not understand that all the sensory functions of life and all thought processes end with death, become worried that the dead person may feel cold, hungry or have undergone great pain if the body was cremated, or not have enough air to breathe if it was buried.

  Perhaps the most important thing is for you to be patient and be available to talk to the child and to share your own feelings of grief with them. This can encourage them to talk, understand and accept death.  It’s also a good idea to have a talk with the child’s teachers at school.  After all, teachers are significant adults in  a child’s life and can be a great help. They should be asked to make sure that while they should be flexible with the child as regards their school work, they should expect and encourage the child to do the work.  Keeping busy is an essential strategy in preventing depression from taking too great a hold.

There are a number of other strategies that can encourage children to grieve in an inclusive, positive way.  Together you can plant a tree or a bed of flowers in remembrance of the person who has died. You could help them create an album of photographs or paintings of your loved one; let the children have some input into the writing of any captions underneath the pictures.  It can also help if you encourage the child to write down their feelings as a journal, poem or a story.  Take some time not only with what is written, but also with the way it’s presented.  You could bind all of it into book form, with covers and, perhaps, a photograph of the dead person on the front.