Bulimia

Bulimia is an eating disorder – but one that is not necessarily easy to spot in one’s own child. Other eating disorders are more visible. For instance, pills almost anyone can recognize obesity – a condition in which the sufferer is significantly overweight. People can also often recognize cases of anorexia nervosa – the condition in which a person is severely under his or her ideal weight (and may therefore look painfully skinny and boney). However, it is not possible to identify someone with Bulimia Nervosa just by looking. The sufferer of this eating disorder may be a perfectly normal weight. It is not the WEIGHT that is disordered in this condition, but rather the way in which the person maintains that weight.  A bulimic (one who suffers from bulimia nervosa) eats way too many calories in one sitting (for example, a number of grilled cheese sandwiches, a full tub of ice cream, a box of crackers, a bag of chips and a plate of waffles). This episode of overeating is called “bingeing.” It is normally followed by feelings of panic (about gaining too much weight), shame and guilt and an intense effort to “undo” the eating behavior by engaging in excessive exercise or using laxatives to empty the gut, or inducing vomiting for the same purpose. Episodes of bingeing and purging (over-eating and then “undoing” the calories somehow) can sometimes occur many times a day. On average, people with Bulimia binge 12 times a week, consuming as much as 11,500 calories. Foods rich in processed sugar and fat, such as pastry, ice cream, bread and donuts are the most common objects of binges.

Bulimia Nervosa is more common than Anorexia, and affects girls more than boys.

Signs of Bulimia
Although parents can’t tell from LOOKING at their child that the youngster is suffering from bulimia, they may be able to discern a problem by observing their child’s behavior. Those suffering from bulimia usually feel a lack of control when it comes to eating. While most of us stop eating when we feel full, those with bulimia keep on eating to the point of feeling pain.  This inability to control their eating can be very embarrassing and typically bulimics try to hide their binging and purging.  Some typical symptoms that may indicate bulimia are:

  • Wanting to eat alone
  • Eating very little in public
  • Frequent trips to the bathroom after meals
  • Disappearance of food
  • Hidden stashes of junk food
  • Eating large amounts of food without putting on weight
  • Excessive exercising
  • Using laxatives, enemas or diuretics

People with bulimia may also have physical symptoms caused by purging.  These include:

  • Puffy cheeks caused by repeated vomiting
  • Discoloured teeth caused by exposure to stomach acid when throwing up
  • Frequent fluctuations in weight
  • Calluses or scars on knuckles and hands caused by putting fingers down the throat to induce vomiting

An Impulse-Control Issue
Are sufferers of Bulimia Nervosa aware that their eating pattern is dysfunctional? Yes. However, they have difficulty controlling themselves; the act of binging and purging is a compulsion. In fact, many Bulimics report that they only stop a cycle of binging or purging when they feel physical pain. Otherwise, they can’t help themselves. They have a compulsion that is too strong for them to overcome, much like an addicts relationship to his substance.

Bulimia Nervosa has been linked to emotional stress as well as body image issues. Low self-esteem, a history of abuse, a difficult life transition, traumatic experiences and other stresses have been found to be higher in those suffering from Bulimia. In addition, there is a higher rate of bulimia in those who are drawn to a body-conscious hobby or profession like modeling, ballet, gymnastics or physical fitness training. It is not clear whether the activity and peer pressure found in the activity actually induces bulimia or whether those with bulimic tendencies (obsession about body image) may choose those activities to begin with.

A Serious Health Threat
Bulimia is a serious health issue. Chronic bingeing and purging can cause serious gastro-intestinal diseases. The purging (in the form of vomiting, laxatives, and diuretics) can lead to electrolyte imbalances, usually in the form of low potassium levels. Low potassium results in symptoms such as lethargy, confusion, irregular heartbeat, and cardiac and kidney dysfunction. In severe cases it can even cause death. Other effects of bulimia may include:

  • Weight gain
  • Constipation caused by chronic laxative use
  • Abdominal pain and bloating
  • Tooth decay
  • Chronic sore throat and hoarseness
  • Broken blood vessels in the eyes
  • Weakness and dizziness
  • Loss of menstrual periods
  • Acid reflux

Risk Factors
Bulimia generally begins in adolescence and 90 – 95% of those with the disease are women.  There is no single cause for bulimia but low self-esteem and poor body image are often contributing factors.  Some of the more common risk factors for bulimia are:

  • Dieting – people who diet on a regular basis are more likely to develop an eating disorder than those who don’t.
  • Involvement in professions/activities that emphasize weight control – the pressure placed on gymnasts, dancers, models, actors, and other athletes to maintain a certain weight can lead to the development of eating disorders.
  • Low self esteem – this can be a result of abuse, depression, a critical home environment, and a desire for perfection.
  • Poor body image – young women are often influenced by our culture’s glorification of thinness and beauty.
  • Major life changes – bulimia is sometimes a reaction to stress, which can accompany a major life change.  Examples of major life changes may be; moving away from home, puberty, divorce, and the break-up of relationships.
  • Biological factors – since eating disorders run in families there is likely a genetic component.  In addition, research indicates that low serotonin levels play a role in bulimia.

Treatment for Bulimia
Treatment for Bulimia should be a combination of a medical and a psychological program. At times, an in-patient weight management program needs to be implemented alongside counseling in order to address the two critical aspects of the illness. Most often, however, bulimia is effectively treated on an out-patient basis. People do heal from this disorder. They may have relapses occasionally but when they learn effective stress-management techniques they can usually prevent relapses over the long-run. Seeking counseling and using self-help strategies are both important for long term recovery.

Psychotherapy is the main form of treatment for bulimia.  Specifically, cognitive behavioural therapy is often used to break the binge-and-purge cycle and change unhealthy thought patterns.

Medication such as anti-depressants may also be used.  These help to reduce binge eating and treat the depression that is often a part of bulimia.

Suicidal Feelings

A certain number of people kill themselves each year, most of whom were suffering from severe depression. Fortunately, 90% of people with depression are able to live full lives while managing their episodes of depressed mood. Only about 10% will end their lives (this number depends on where a person lives – countries vary in their availability of effective treatments and support for depression, so there is a wide international variability in suicide rates).  The pervasive sad mood that comes with depression, as well as the increased tendency among the depressed to obsess on negative thoughts, makes them susceptible to the hopelessness and irrationality characteristic of the suicidal person. People do not “choose” suicide; they fall victim to it as part of their illness.

What are the Implications for Parents?
The link between suicidality and depression should serve as alarm bells when helping our children deal with mental health issues. If we have a loved one who is suffering from depression, it is always prudent to watch out for signs of suicidality. A depressed child is at risk for succumbing to suicidal thoughts; it is up to parents to help prevent this. Vigilant parents can be familiar with the warning signs of suicidality and take action. Moreover, they can do everything possible to get their child the right kind of help. In addition, they can work hard to reduce the other stressors in the child’s life – like school work (negotiate accommodations with the school) and conflict in the home. In fact, when the parents work on their own marriage and parenting skills to increase peace in the home, this can help tremendously.

What are the Warning Signs?
According to the American Academy of Child and Adolescent Psychiatry these signs are:

  • Change in eating and sleeping habits
  • Withdrawal from friends, family, and regular activities
  • Violent behavior or running away
  • Substance abuse
  • Neglect of personal grooming
  • Personality change
  • Difficulty concentrating, persistent boredom
  • Drop in academic performance
  • Marked personality change
  • Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
  • Loss of interest in previously enjoyable activities
  • Speaking positively about death or romanticizing dying (“If I died, people will appreciate me more.”)
  • Writing about death, dying, or suicide
  • Engaging in reckless or dangerous behavior; being injured frequently in accidents
  • Giving away or discard favorite possessions
  • Saying permanent sounding goodbyes to friends and family
  • Seeking out weapons, pills, or other lethal tools

A child or teen  who is planning to commit suicide may also:

  • Complain of being a bad person or feeling rotten inside
  • Give verbal hints with statements such as: “I won’t be a problem for you much longer.”, “Nothing matters.”, “It’s no use.”, and “I won’t see you again.”
  • Become suddenly cheerful after a period of depression
  • Have signs of psychosis (hallucinations or bizarre thoughts)

The risk of suicide is high among those who have attempted suicide before, know someone who has killed themselves, and are pessimistic about the chances of getting relief from chronic depression. Also, teens who have a family history of mental illness and suicide are more likely to attempt suicide as are teens who have clinical depression or who suffer from active addiction. Teens who’ve already made a suicide attempt have a higher chance of committing suicide successfully. Vulnerable teenagers who suffer a serious loss (like the breakup of a romantic relationship) may try to stop the pain with suicide. A history of physical or sexual abuse, incarceration, alienation from parents and refusal to access mental health services all increase suicidal risk. Males have a higher “success” rate for suicide than females, but females make many more suicide attempts than do males. Also take note if your depressed child suddenly seems unusally happy. Sometimes this switch in attitude happens because a child has decided to end his suffering and he is actually experiencing a state of relief. Remember that depressed mood is a serious and potentially life-threatening condition and should always be professionally treated.

The American Academy of Child and Adolescent Psychiatry recommends taking a child’s suicidal statements seriously. If a child or adolescent says, “I want to kill myself,” or “I’m going to commit suicide,” ask him what he means. Don’t be afraid of saying the word “suicide.” You won’t be giving the teen an idea that he hadn’t thought about. Instead, you’ll help him or her think things through. Ask about depression, anxiety and unhappiness. Don’t just tell the child no to talk that way.  Show interest and concern and get your child to a qualified mental health professional (such as a psychiatrist or clinical psychologist).

Suicidal Behavior in Teens
Teenagers are a vulnerable group. They experience tremendous pressure from all sides: from inside their changing bodies, from their parents, from their schools and from their peers. No one can be perfect in every area and so everyone is doing poorly in something. But teenagers can feel isolated with their failures and setbacks, lacking the perspective that older people have that “we’re all in this together.” Teenagers are intent on fitting in, looking good, being acceptable. If the only group they can fit into is a violent, drug-ridden street gang, then that’ll be the group they might very well join, especially if they have little support elsewhere or few sources of success and strength.

Because the pressure is so intense, many teens do not cope well. Their survival strategies depend to a large extent on their genetic make-up and the strategies they learn at home. Some teenagers have “hardy” genes that help them survive and thrive under stressful conditions. They can laugh their way through almost anything or simply tough it out. Others are genetically vulnerable to bouts of depression. However, the depressed teen is more at risk than depressed adults. Teens are very focused in the present. They have trouble imagining that in a few years life can improve tremendously. Their impulsivity can lead them to put an end to it all right now because they just can’t see any way out.

What You Can Do
Parents can also help buffer teens from stress by keeping the doors of communication open. Make it easy for your kids to talk to you. Keep criticism to a minimum; instead, give praise and positive feedback generously. Have fun with your teenager and try to make your home pleasant, comfortable and safe. Keep conflict down with your spouse. Avoid drama. Take care of yourself and create a healthy model of stress management strategies for your kids to learn from. Create a positive atmosphere. Have a dinner table several times a week and use it to have discussions on politics, human nature, interesting things in the news or whatever—keep talking with your kids. Make your values clear. Bring tradition and ritual into your home.  Accept all feelings without correction or disapproval. Ask for behavioral change gently and respectfully. Never yell at your teenager. Never insult, name call, use sarcasm or any other form of verbal abuse. Instead, be sensitive to your teen’s feelings at all times. Discipline when necessary but only after you’ve warned a child that discipline will occur and only with mild discipline—never affecting the teen’s social life (see Raise Your Kids without Raising Your Voice for safe and effective ways of guiding teenagers).

If your teen demonstrates any of the symptoms of depression or suicidality, talk to him or her about what you are observing and arrange an appointment with a mental health professional. You can call suicide helplines in your area to get information about how to help your child. You can take your child for a mental health assessment. If your child is uncooperative, seek mental health guidance yourself. Since a suicidal person feels isolated and hopeless, any steps that family members take to address the situation can be powerfully preventative. Remember, too, that many parents have walked this road before you. Access on-line and community support if your child has been threatening suicide.

Depression in Teenagers

The teenage years are known to be emotionally challenging. Kids are going through so many transitions and are experiencing so many pressures at this time. Aside from the physical changes of puberty and their effect on body image and personal confidence,  there’s also adjustments to high school and dating and new challenges in the realms of alcohol, drugs, sexuality and the virtual social universe. For the most part, adolescents negotiate all of this without too much trouble. However, a percentage of teenagers will struggle with addictions and mental health challenges. Adolescence is the time when many people first experience panic attacks, eating disorders and mood episodes.

Teenage depression is one mood disorder that is fairly common, affecting around 20% of teenagers. Some forms of depression are comparatively mild while others can be so intense that they are life-threatening. In all cases, adolescent depression must be taken seriously. Parents need to know about depression and what they can do to help their kids.

What is Depression?
Depression is a mood disorder characterized by low mood (which, in teenagers, is most often expressed as irritability or “moodiness,” but can also be expressed as sadness), hopelessness, trouble making decisions, feelings of guilt or worthlessness, weight gain or weight loss and sleeping problems (most commonly, waking up around 2 or 3 a.m. or getting up way too early).  Unlike episodic sadness, depression is stronger and seems harder to manage. A person who is depressed cannot simply “shake the blues away” or decide to cheer up. In fact, they feel flat, like there is nothing that can make them happy or give them pleasure. When this state of mind is so intense that it interferes with a child’s social functioning (i.e. she is withdrawing from her friends) and/or academic functioning (i.e. she can’t concentrate, can’t study, is doing poorly in her schoolwork and grades are slipping) and it has occurred pretty consistently for a two week period, it may be an episode of “Major Depressive Disorder.” When the state of mind is less intense (does not interfere with social or academic functioning) and chronic (lasting for at least 2 years fairly consistently), then it may be a form of depression called “Dysthymia.” Of course, diagnoses of either of these disorders occurs when the mood disorder is NOT being caused by something else (like withdrawal from drugs or use of alcohol or a traumatic experience, etc.). The only real way to know if a child is depressed is to have her assessed by a psychiatrist or clinical psychologist. The child’s symptoms may indicate another disorder entirely or the child may be “normal” – just going through a rough time. However, it’s crucial that parents don’t try to diagnose their child themselves. Clinical depression can lead to suicide in teenagers.

Experts believe that depression has a biological origin. While a family history of depression doesn’t automatically condemn a teen to get the disease, it increases the likelihood of depression when other risks factors are present in the child’s life. Risk factors for teen depression include a history of childhood depression (chronic unhappiness in childhood), instability in the family, troubled or weak relationship with parents, poor emotional management skills (too much anger, moodiness or anxiety), lack of social support (good friends and/or loving relationships) and stressful life events like loss (of a significant relationship) or failure (to make the team, or get desired grades, etc.).

How can Parents Help a Teenager with Depression?
It’s ideal if you can establish an open relationship with your child before depression strikes. This way, she is more likely to come to you for help when what she is feeling becomes too overwhelming to ignore. You can help by listening. In fact, it is more important to listen than to talk. A depressed child does not need a pep talk. She needs professional care. Let her talk about her feelings without offering her advice or easy solutions. Instead, use emotional coaching (name her feelings). For instance, you can say things like, “That sounds really hard,” or “I can see how much that’s bothering you” or “I hear how hopeless you feel.” Follow such remarks with, “I think the best help for these kinds of feelings is professional help. A psychologist who works with teenagers knows all about this stuff and knows how to help kids feel so much better. These are such important issues and they deserve the best help that we can find. How would you feel if I asked Dr. Green (the child’s pediatrician) for a referral to a good psychologist?” If the child doesn’t want to accept help, wait a couple of days and raise the subject again. The best help you can give your child is to get her to a mental health professional. If firmness is required, then use it. Do whatever you would do if you suspected that your child had diabetes. (You would do whatever was necessary to get your child to a doctor; do the same thing for this condition). Your child will thank you once she is experiencing an improved mood!

Child Ignores Alarm Clock

Whoever invented the snooze function in the alarm clock, is both a genius and a fool. The “genius” element stems from the fact that people don’t like to just suddenly jump out of bed in the morning – they crave a more gradual wake-up process, allowing body and mind to adjust to the new day in a series of small steps. When an alarm rings or buzzes, the sleeper wakes up, but by hitting the snooze function, he or she can drift back to sleep. The alarm sounds again and wakes the person again and the person hits it again, falling asleep again – but not very deeply. After a number of times of sleeping, hitting and waking, the person finally becomes alert and ready to start the day. The “fool” component of snooze alarms is that they actually train a person to IGNORE the alarm clock and continue to sleep in. Whereas the alarm is supposed to get the person out of bed, the snooze function allows them to stay in bed indefinitely!

If your child belongs to the “just one more minute” club, consider the following tips in weaning him or her off the habit:

Buy an Alarm with No Snooze Function
If your child knows that the first ring is the only chance of getting up on time, he or she might be more inclined to respond to that first ring.

Set a Limit for Snoozes
Buy an alarm clock that has limited snoozes allowed. Or perhaps an alarm clock that can be set for only one or two snooze hits. This way your child still gets to hit the snooze button— but not so many times that they end up sleeping in too late.

Be the Snooze Button
Snooze alarms are tempting to disobey because they are just machines – they don’t give you a disappointed look or a jarring physical shake. And if your child’s relationship wit the snooze button is really dysfunctional, perhaps you as a parent can help out. Once you hear the first alarm, just quietly enter the room and check if your child is already awake. If not, give them 2-5 minutes, and then wake them yourself by turning on the light, opening the blinds and talking to them or singing to them until they show signs of life or until 3 minutes have passed (whichever comes first). Leave the room and let your child get him or herself out of bed. The trick is to help but not to actually replace an alarm clock. Ultimately, your child has to learn how to get him or herself out of bed. Y

Place the Alarm Clock Far Away
Another technique is to just make it extremely difficult for your child to go back to sleep once the alarm has gone off. One way of doing this is to place the clock all across the room. This way, your child will have to stand up, walk to the clock, hit the snooze button, and travel all the way back to bed before he or she can resume sleeping. By the time your child’s head has hit the pillow again, he or she will be fairly awake already from the standing and the walking.  You might also consider the new “annoying” alarms that are available on the market – alarms that jump madly all over the room (and the child) until they are turned off, alarms that have a “boom” that will awaken the whole street, and alarms that get louder and louder, the longer they are left ringing.

Following the same principle, you may install many alarm clocks, and place them in different places. If your child has to attend to more than one ringer, he’ll be awake by the time he or she gets to the last!

Instill Healthy Sleeping Habits and Better Time Management Skills
At the end of the day, the best way to get children to rise on time is to ensure that they’ve had adequate sleep and that they know how to get themselves into bed at a reasonable time. Young children need to be regulated – it’s up to parents to establish bedtime routines and times. As the child gets older, however, he or she will have greater personal responsibility for getting into bed at the right time in order to get enough sleep. Parents can help by setting up negative consequences for failure to be in bed on time. For instance, a child who is supposed to be in bed at 9:15 but is wandering around the house or still playing on the computer at that time, may be subject to a rule that has been established such as, “failure to be in bed on time costs you X amount of your allowance dollars” or “failure to be on time means that I will not help you wake up in the morning” or whatever.

Use Consequences
Alternatively, make consequences for failing to be on school on time. Then leave it up to the child to figure out how to get out of bed by him or herself. Don’t tell the child what time to go to bed or how to get up. If the child really doesn’t like the consequence, the child will figure out how to use his or her alarm clock appropriately

Grumpy or Abusive Upon Awakening

Parent: “Good morning, sweetie. Breakfast is ready – come get it before it gets cold!”
Child: “Get out of my room! “

Mornings can be quite stressful when you’re dealing with a grumpy child. Morning grouches can range all the from snappy and irritable to rude, mean and/or aggressive. They may be also be contrary, uncooperative or outright defiant. In many cases, they can spoil the day before it’s even started.

Sometimes morning grouches are totally pleasant people at any other hour of the day; sometimes they are the logical manifestation of a routinely negative temperament. Whether they are full time grumps or just morning grumps, parents need to know how to get them up and running.

What can parents do with children who are grumpy or hostile upon awakening? Consider the following tips:

Your Child Simply isn’t a Morning Person
It’s the same for children as it is for adults: some are night owls; others are morning people. Whether it’s innate personality, or an inborn biological clock, it may be best to understand that the youngster is “morning-challenged.”  It’s O.K. to accept some morning moodiness, but do not accept bad behavior – including rudeness, violence or any other unacceptable behavior. It’s O.K. if the child cannot greet you with smiles and sunny cheer. It’s not O.K. if the child is unpleasant or mean.

Consider Sleep Factors
Some children and teens are miserable in the morning because they are sleep-deprived. Sleep deprivation can occur as a result of too little sleep (going to bed too late), but it can also occur as a result of poor quality sleep (i.e. caused by sleep apnea or other sleeping disorders). If your child is going to sleep too late, take steps to make sure that he or she goes to bed earlier. However, if your child is going to sleep at the right time, consider speaking to your child’s doctor about the morning issues and ask for a sleep assessment. What you might have judged to be poor behavior might actually be a health disorder.

Make it Pleasant
In less drastic cases, the creation of morning rituals may be enough to ward off the morning grumps. Some children wake up stressed and/or anxious about the day ahead. Rituals are very soothing, especially for the very young. If you have a young child who has mood issues in the morning, perhaps charting a structured morning routine can help. Use your imagination and make it fun as well as easy to follow: songs, poems, and stories may help move the morning routine along. For school-age kids, read a couple of knock-knock jokes instead of offering the traditional “time to get up” notice.  Consider using a funny or fun alarm clock – this can work nicely for teens too. Or, use a graduated alarm clock that uses light and pleasant tones to gently awaken the slumbering child. Play the child’s favorite music on speakers. Keep the atmosphere light and positive. Spray the room with calming essential oils or – in the case of aggressive morning kids – Rescue Remedy spray. When your child does show any sign of improvement, make sure to offer acknowledgement, praise and even reward – you want to encourage him to continue to work in the right direction.

Use Discipline if Necessary
Some kids (and adults!) are rude in the morning simply because they can be. No one is stopping them. And yet, these same youngsters suddenly improve their ways when someone “lays down the law.” Showing a zero tolerance for morning abuse, backed up by appropriate consequences, can stop morning abuse in its tracks. Remember, you’re not asking your child to feel happy about having to get up in the morning; you are only demanding that the child act in a respectful manner no matter how tired, irritated or displeased he or she might be feeling. Use the 2X-Rule to structure a plan of discipline. The next time your child is verbally abusive or otherwise disrespectful in the morning, tell him or her the new rule: “It’s not O.K. to speak to me in an unpleasant tone of voice or to say unpleasant words because everyone deserves to be treated with respect at all times. If you are in a bad mood in the morning, that is fine, but you need to speak and act respectfully nonetheless.”  Then, when the child behaves inappropriately on another day, repeat the rule and add the warning of consequences to come. For instance, “If you are in a bad mood in the morning, that is fine, but you need to speak and act respectfully nonetheless. And from now on, when you behave this way, such & such consequence will occur.” Name a specific negative consequence (see Raise Your Kids without Raising Your Voice by Sarah Chana Radcliffe for more details about the 2X-Rule and for ideas about selecting age-appropriate consequences). On the third occasion of rudeness or lack of cooperation, apply the consequence. Use the same consequence as long as you are seeing improvement in the morning rudeness but, if after 3 or 4 times of using the same consequence there is still no improvement, change the consequence and try again.

Consult a Professional
If you have tried all these interventions and your child is still grumpy upon awakening, do consider speaking to your child’s pediatrician about the issue.

Sleeping Issues

There are many sleeping issues that babies, children and teens may have. Many of them are the “normal” sleeping issues that almost all parents deal with in the course of raising children: in one way or another, the child isn’t sleeping enough. Perhaps the child isn’t sleeping right through the night, or isn’t going to sleep early enough, or is waking too early. It’s true that some kids wake up too late, but those children usually went to bed too late also. (It’s also true that some kids go to bed on time and get up late, meaning they are getting too much sleep, but this is a relatively rare sleeping problem that is usually attended to by the child’s medical doctor.)

However, there are other fairly common sleeping issues that youngsters may have includiing some of the following:

  • suffering from night terrors (screaming with fear without dreaming, can’t be consoled, forgetting it happened)
  • suffering from nightmares (experiencing scary dreams, usually remembered upon waking)
  • experiencing insomnia (trouble falling asleep or staying asleep)
  • suffering from restless leg syndrome (painful or uncomfortable sensations in the limbs that disturb sleep)
  • breathing problems like sleep apnea (interrupted breathing that causes snoring and/or waking throughout the night)
  • sleep-walking
  • experiencing unrestful sleep
  • tooth grinding

There are also other, more rare, disturbances of sleep that can affect people of all ages. If your child has any sleeping problem whatsoever, consider the following tips:

Common Causes of Sleep Issues
The “normal” sleep issues are caused by childhood! Babies just want to be with their parents 24/7 and suck and snack throughout the night. Toddlers also want to be with their parents and tend to wake with the sun. School-aged and older don’t like to go to bed – they are too enthused by life and all its stimulating activities. Adults also often have that problem! In our modern society, light bulbs give us the opportunity to keep  active all hours of the day and night and with the exception of a small number of children, adolescents and adults, most people want to stay up too long.

In addition, dietary factors may affect sleep. Having too much caffeine in the evening (available in soda as well as chocolate, coffee and tea) can cause excessive wakefulness at bedtime. Sugar can do the same.

Many sleep problems can be caused by physical and emotional issues. For instance, depression, anxiety and ADD/ADHD are just a few of the many disorders that can affect a child’s ability to sleep well througout the night. Depression can cause wakenings between 1 and 3a.m. or early termination of sleep around 4:30 or 5a.m. Anxiety in the form of “separation anxiety” can prevent children from sleeping happily in their own rooms or their own beds. ADHD can cause problems in settling down to sleep, staying asleep, or feeling rested by sleep. Physical conditions such as chronic pain, itching, breathing problems, endocrine and metabloic diseases, neuromuscular disorders and many other conditions can interrupt sleep.  There are also substance-induced sleep disorders caused by alcohol, illegal drugs and medicines.

What can Parents Do?
The normal sleep issues are best addressed by healthy sleep routines (see the articles on “bedtime problems” on this site). Understand that babies and small children normally wake many times in the night and eventually outgrow this practice (with or without help from their parents). You can read all the sleep books you want, but if your child still has waking issues, keep in mind that this is normal in kids up to around 5 years old or so. Nonetheless, always describe your child’s sleeping difficulties to your pediatrician just to rule out medical causes.

Helping Them Fall Asleep
Some babies, kids and teens have trouble getting into sleep mode. They cannot settle down either emotionally or physically or both. It’s as if their “on button” is stuck in the “on” position! These children can benefit from a wide range of interventions that your pediatrician, naturopath and mental health professional can suggest. Be prepared to spend time and effort in experimentation – it takes professionals awhile to diagnose the cause of sleep-onset disturbances and it takes parents time to see which interventions will make a positive difference. Don’t blame your child for having this sort of trouble. He’s probably not very happy with the situation either. Older children and teens may be able to participate in their “cure” by learning relaxation techniques (meditation, visualization, breath work) or modifying their habits (to include more exercise, dietary changes, quieting activities in the evening). Even so, the “how-to” of good sleep hygiene may have to come from a professional rather than the parent. Somehow kids take outside “authorities” more seriously than Mom and Dad.

Getting Them Back to Sleep
It would be less of a problem if those children who woke up didn’t wake their parents up! If they would wake up and then just turn over and go to sleep, it would actually be a totally normal process – humans don’t actually tend to sleep 8 hours straight without interruption. Rather, they wake up frequently during the night but then go quickly back to sleep. Parents work hard to help their youngsters stay asleep all night, but their efforts would be better directed to helping children soothe themselves back to sleep. Again, a team of professionals may be helpful in this regard, offering self-help strategies ranging from relaxation strategies to sniffing essential oils that have been prepared for the occasion. Breathing problems can contribute to frequent waking, as can other physical health conditions, so it is important to talk to your child’s doctor about this symptom. In fact, be sure to tell your child’s doctor everything you can about your child’s sleeping problems. Even if everything checks out fine on the physical front, parents will want to do something up their child’s night time wakefulness. Naturopaths may be of assistance: professional herbalists, for instance, can sometimes create a special tea for the child that will strengthen the youngster’s ability to sleep deeply and steadily through the night. Homeopaths may be able to address the condition as well. Sometimes hypnotherapists or child therapists will have expertise in this area as well. Sometimes nothing will help the child stay asleep, but parents can still help the child to stay in his bed – mental health professionals can provide techniques ranging from positive reinforcement to negative consequences.

Consult a Professional
In any case of sleeping issues, do consider consulting your child’s pediatrician for further advice and guidance.

Always Late

Some people are always late. Children, teens and adults can all be afflicted with the lateness syndrome. If you are always late, cure YOURSELF before trying to cure your child. However, if you’re a prompt parent dealing with an always-late child, consider the following tips:

There Are Many Reasons for Arriving Late
First, let’s differentiate between “excuses” and “reasons.” When a child says she was late for school because her alarm didn’t go off, she is giving an excuse. Blaming traffic, weather conditions, alarm clocks, losing things and so on does not actually explain late behavior – these are all excuses. A reason for lateness is a statement that actuallyexplains why the person is late. For instance, “I didn’t allow enough time for bad traffic conditions,” explains why traffic conditions caused the person to be late. There’s ALWAYS traffic conditions! Why does that make some people late while other people are still on time? Because some people allow enough time for things to go wrong and some people leave themselves no “wiggle room” for ordinary life events. Similarly, weather conditions happen all the time. Failing to allow for weather is what causes only some people to be late while others are still on time. In other words, people who arrive on time understand and utilize the principles of time management whether or not they are doing so consciously. They know that you have to allow for “unforeseen events” every time you make an appointment to be somewhere. If unforeseen events don’t happen, they’ll arrive a little early. They can prepare for that eventuality planning for it – bringing some reading material, handheld devices or whatever, to keep busy for a few minutes before the appointed time arrives. Chronically late people don’t want to wait. Therefore they leave at the last minute so that they’ll arrive “just on time.” This does not allow for the necessary “wiggle time” – they will be late a lot of the time.

There Are No Consequences for Arriving Late
If the school does not give detentions or other immediate punishments for being late, children may not feel that they need to be on time. Or, if the detention period isn’t unpleasant, then the child may not care that he or she received a punishment. Schools who are serious about having kids turn up on time, need to have serious consequences for failure to do so. Similarly, parents may need kids to be ready to leave the house at a certain time so that the parents can leave for work. Dawdlers and late risers can pose a threat to the parent’s job responsibilities. A child who causes the parent to be late because of his or her own slowpoke behavior, needs to suffer appropriate consequences. Use the 2X-Rule (explained in detail in Raise Your Kids without Raising Your Voice by Sarah Chana Radcliffe). Tell the child that if he or she makes you late in the future then there will be a specific punishment (name what that will be). Be consistent in enforcing the negative consequence and be sure that the consequence you are choosing is a true deterrent for the child.

Consider Specific Disabilities That Make Time Management Hard
There are various neurological deficits that can make time management hard for a child. Some children just can’t accurately judge the passage of time. Twenty minutes may pass while the child experiences it as if only a few minutes went by. Or the child figures it will take her minutes to put on clothes and make-up whereas it never takes her less than 25 minutes for the task. Some kids can’t judge how long it will take to dress, eat breakfast, clean up and get ready for the bus, despite the fact that they must do it every day. Keep in mind that many adults have the same problem! If your child has conceptual difficulties around time, he or she will need extra help. SIt down with the youngster and ask him or her to make guesses of how long each task takes. The next day actually time each tastk. If the child is overor underestimated, discuss the differnces. Help the child make a more realistic schedule and have him or her check off the times that are actually required for each task. Close monitoring for a few days may reveal a few “leaks” in the system – just a couple of places where more time must be realistically allotted.

Accidental Reinforcement
Sometimes a child gets a lot of attention for being late. A parent might call him, scold him, encourage him, help him, and otherwise be all over him all morning long to make sure he is moving on time. This can be a lot of attention! Children sometimes enjoy all the “help” and attention they get from their parents around the issue of arriving on time. Even if this attention is unpleasant (scolding, reprimanding, threatening and punishing), the child might “enjoy” it, because negative attention is better than no attention at all. So be careful to check your own behavior to ensure that you are not talking to the child a lot in order to help him or her be ready on time. Stop the reminders, the assistance, the threatening and all the other attention. Go have your own breakfast and relax. The child will probably beg for attention in the beginning, so you must be firm in your resolve not to give it. After awhile, the child will realize that no more attention is coming and he or she will begin to act more normally.

Defiant Behavior (ODD)

“I’m not eating that!”

“I can leave class anytime I want to. You don’t own me.”

“No. Make me!”

Do you have a child who is consistently negativistic, argumentative and hostile? Does it seem that every little issue in your household turns into a major battle? If so, you are probably exhausted! Parenting has turned out to be a struggle rather than the pleasure you expected it to be. And you are probably also confused – why is your child acting this way? Is there something you have done wrong? Or is there something wrong with your child?

There are  many reasons why your child may be this way, ranging from normal temperamental issues and  periods of intense emotional stress all the way  to various mental health diagnoses. In this article we will examine one possible cause of consistent defiant behavior: ODD – Oppositional Defiant Disorder.

Why Do Kids Misbehave?
Misbehavior is normal for any child; part of the natural developmental process involves testing parental limits. In addition, stress can make kids irritable and less able to control their behavior or their mouths. Sick, overwhelmed, hungry or tired kids disobey, talk back, argue or even deliberately trample parents’ authority. Sometimes, simple lack of knowledge or inexperience is the culprit behind misbehavior.

However, when a child defies authority regularly and consistently – across all situations and independent of other factors like stress, fatigue and so on – it is possible that he or she is suffering from a condition called Oppositional Defiant Disorder or ODD.

What Is Oppositional Defiant Disorder?
Oppositional Defiant Disorder is a chronic, pervasive pattern of being uncooperative, defiant and hostile to authority figures like parents, teachers and most adults. ODD symptoms are far more intense than ordinary misbehavior, impairing a child’s ability to function well at home or school. Sibling relationships and friendships are also affected.

Children with ODD have frequent temper tantrums and other dramatic displays of displeasure, engage in excessive arguments with adults, constantly challenge or question rules, and deliberately attempt to annoy or upset other people. They’re also prone to blaming others and exhibiting vengeful behavior. Symptoms usually occur at both home and school. ODD most frequently  occurs along with other diagnoses such as Attention Deficit Hyperactivity Disorder (ADHD), learning disabilities, mood disorders and anxiety disorders. ODD is estimated to affect 3 to 16% of the population of children and teens. It can manifest as early as a child’s toddler years.

What Causes ODD?
Experts point to a combination of factors including biological (e.g. an impairment on the area of the brain that manages impulse control and emotional management), social (e.g. harsh and punitive parenting techniques, stressful family transitions, difficulty relating with people) and cognitive (e.g. poor problem-solving skills, irrational thinking) issues. It is recommended  that interventions for a child diagnosed with ODD are also holistic, addressing the whole child.

What Can Parents Do?
If you suspect that your child may have ODD, consult a pediatric mental health professional for assessment, and if necessary, a treatment plan. Once a diagnosis has been made, there are strategies that parents can employ to help their child with oppositional behavior. Management of ODD may involve therapy, medication and behavior management programs to be carried out at home and school. Positive parenting styles have been found helpful as well in the treatment of children with ODD. In particular, taking the power struggle out of parenting can lessen the tendency for the child to fight authority. When parents don’t offer strong emotional reactions to provocation, kids lose interest in trying to provoke them. Parents of ODD children can take specialized parent education training.

Although many children with ODD will benefit significantly from medication, parents can also experiment with Bach Flower Remedies instead of or along with psychotropic medication. Behavioral and psychological interventions will still be required. The remedies Vine (for defiance and hostility), Chestnut Bud (for disregard for authority), Heather (for drama and the need for attention) and Cherry Plum (for loss of control) can be added together in one mixing bottle and offered 4 drops at a time, 4 times a day until the defiant behavior has significantly improved. You can find more information on Bach Flower Remedies online and throughout this site. Before starting your child on the remedies, note how many times a day he or she currently engages in tantrums and arguments. Record the child’s behavior for a month while the child is taking the remedies. If there is a positive effect, continue as is, but if no difference is noted, be sure to consult with your doctor and/or psychiatrist for proper assessment and medical treatment.

Kleptomania

People often assume that a thief steals for a reason. However, link the truth is that stealing doesn’t always have a practical purpose and not everyone who steals is a “thief” in the true sense of that word. A child may be caught stealing something he doesn’t really want nor need, pharm something he already has, or something of very little value. A child may also steal for the sake of stealing, not because of a need for attention, a desire for revenge or a show of inadequacy. When someone steals without any obvious gain, it is possible that he or she is suffering from a mental health condition called kleptomania.

What is Kleptomania?
Kleptomania is a mental health condition characterized by a strong urge to steal, and a feeling of relief after stealing. It’s an impulse-control disorder, similar to Obsessive-Compulsive Disorder, where the patient suffers from persistent thoughts and repetitive patterns of behavior. Kleptomania usually has its onset in young adulthood, but there are cases of kids as young as 5 years old with Kleptomania.

Are Kleptomaniacs Criminals?
Kleptomania must be distinguished from the criminal act of stealing, or the willful and knowing theft of someone else’s property. People with Kleptomania steal not because they want to, but because they feel they have to. They experience extreme anxiety when they do not give in to the behavior of stealing, and stealing is the only way they can get relief. They know that what they do is wrong, but they can’t help it. In fact, many kleptomaniacs steal things that have little value, such as paper clips or tissue paper rolls. They may also return what they have stolen afterwards, as they are not particularly interested in the stolen object itself, but rather the act of stealing.

How is Kleptomania Treated?
The dynamics behind Kleptomania point to how the condition should be handled by parents, teachers and helping professionals.

It’s recommended that Kleptomaniacs (those who suffer from Kleptomania) not be punished for their stealing, as they have a mental health condition that needs help and healing – not punishment. In fact, many researchers argue that Kleptomania, like all impulse-control issues, may have a physiological origin. Abnormally low amounts of the neurotransmitter serotonin in the brain may be the cause of Kleptomania.

Counseling is an appropriate first response to a child with Kleptomania. Except for really young children, people with Kleptomania are aware that what they are doing is dysfunctional and they are often stressed, even depressed, about what they are going through. Helping a child vent his or her feelings over the inability to control impulses is a good start.

Cognitive-Behavioral Therapy has been known to assist children with Kleptomania in managing their urges and compulsion. Skills in stress and anxiety management are also helpful, as it is stress and anxiety that often compel a kleptomaniac to steal. Gradually sensitizing a child to the impact of stealing on other people can also be a way to help kids with Kleptomania manage their condition.

When therapy alone fails to cure the condition, psychotropic medicine of the type used for obsessive-compulsive disorder may be prescribed.

Reducing Stress at Family Gatherings

While the idea of happy family gatherings is heartwarming, the reality of these get-togethers is more complex. Family gatherings can be fun or they can be stressful. They can be uplifting or maddening – or they might be a little of everything! It all depends on who is in the family and how you feel about them. Family members are people who are thrown together by birth and marriage; they are not like friends we have carefully chosen. These are people we must deal with whether we like them or not. Quite often, there are difficult people included in the group who may have caused us pain and aggravation. Usually, there is one or more person who has hurt us and disappointed us and there are some others who are just plain annoying.  Fortunately, there are also likely to be some who we truly enjoy being around. All of these “loved ones” come together for family celebrations and holidays to enjoy feelings of closeness and community.

Let’s look at some tips for minimizing stress and increasing the pleasure of these gatherings.

Family Relationships are Important to Kids
Children are nourished by family gatherings. The extended circle of love makes them feel secure in a world which is often fragmented and isolated. The ritual celebration of holidays brings a sense of stability and meaning to the child’s world. If your children are going to experience the family scene, you can help to make it as positive as possible for them by keeping your negative thoughts to yourself. Children do not benefit from hearing how you can’t stand the sight of Uncle Joe or how you will not be talking to Cousin May. If you have any conflicts with any family members, try to keep them under wraps for the duration of the gathering. Kids don’t have to know all of your business. Even if YOU don’t like a certain family member, you can still allow your child to enjoy that person’s company. (If you think that anyone is a threat of any kind to your child’s well-being, either don’t invite the person or don’t allow your child to attend the event).

Prepare Kids in Advance
Let your children know what you expect of them in advance. If there are rules you wish to establish (no yelling, running, cursing, grabbing or whatever), tell them before the gathering. You can also warn them that there will be negative consequences AFTER the gathering if they misbehave. Try very hard not to discipline children during a gathering as the embarrassment they feel can harm them. Of course, you’ll need to be realistic too – children who are seeing their cousins and other relatives can get over-excited and a bit wild. From their point of view, they may be having the time of their lives. Simply remind them quietly to settle down if necessary.

Do Not Disturb the Festive Atmosphere
Refrain from anything that might contribute to tension at the gathering. Don’t talk about “hot” topics. Don’t correct your spouse in public. Don’t criticize anyone or anything. Don’t argue with a relative about anything – it isn’t worth it. Your job is to keep the gathering upbeat and positive. This is a party! Keeping it this way is your gift to your children.

Teenagers are Independent
Often, teens go through a period where they don’t want to attend family gatherings. Usually this is temporary. Once they have found a life partner or  have kids of their own, they’ll be very interested in family gatherings again. Meanwhile, you can ask your teens to please attend for a short while and then allow them to go to do their own activities whether that involves leaving the house to be with their own friends or going to their own rooms to pursue their own activities. If your teen really doesn’t want to come for even 5 minutes, don’t push it; this may change by the next gathering or over the course of the next few years. As long as you report having a great time, the door remains open for your teen or young adult to join you on another occasion. If your adolescents are happy to attend the gathering – that’s great! You might even put them to work! At this age, they can help with serving and clearning or table setting or whatever. Try to listen to their ideas and suggestions and implement them, giving them a voice in how things will be set  up, arranged or conducted. This can help them “own” the scene and enjoy it even more. If you are at another relative’s home, encourage your teens to offer their assistance. This is sure to earn them positive feedback, helping them to feel important in the family scheme of things. But don’t over do it – a few minutes of helping is all that is necessary. Let your teens just relax and talk to people. Welcome them in joining the “grownups” in more adult conversation if they show an interest to be there. If they want to hang with the young people, be careful not to correct them or criticize them in front of others. No warnings not to drink too much and so on – do all of that in private before you get to the party. This is not the time to be “parental.” Just smile and wave!  By treating your teens as if they are no longer little kids, you can help them become “young ladies and gentlemen” within the family context – you are promoting them to the next level. When they experience their enhanced status, they are more likely to want to attend future gatherings.