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Child development

Potty Training Sucks. Here Are 8 Sanity Saving Tips.

By October 13, 2015 3 Comments
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In my first post here on The Scientific Parent, I’ll be discussing one of the least scientific areas of pediatric medicine — potty training. Pediatricians have a lot of scientific evidence to guide us towards appropriate treatment of ear infections, asthma, and a lot of other problems. But when it comes to advising parents about potty training, pediatricians are free to practice their recommendations — as one of my colleagues likes to say —“unencumbered by evidence.”

If you ask a preschool teacher when to potty train your child, the answer may be “before they start preschool” (because, while it’s not easy to herd a room full of 3-year-olds to the bathroom, it sure beats changing diapers). But ask the same question to a pediatrician, and you’ll probably get a far more nebulous answer like “wait until they’re ready.” I know it feels like we say that just to frustrate you (and it indeed, it leaves you frustrated), but the truth is that in this situation there’s not a single correct answer.

There’s a lot of variability in the ages at which children are potty trained. Girls tend to pick it up slightly faster than boys. Children from lower socioeconomic conditions, as well as those in African-American families, tend to potty train earlier. And if you compare American kids to those in many other countries, we’re way behind the curve, mostly due to vastly different definitions of “potty trained.”

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Categories: Ages + Stages, Mental, Emotional, + Behavioral Health, Toddlers + Preschoolers

It’s Official: We Can All Calm Down About Screen Time

By October 6, 2015 4 Comments
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Pediatric use of screen time is something I’m a little sensitive about. I spent six months of my life working on it and for six months of my life it was all screen time, all the time. Once my portion of the project was over I swore I would never talk about screen time again, that’s how exhausted of the topic I was.

But frankly, I’m tired of seeing parents shamed for allowing their kids watch an episode or two of Daniel Tiger’s Neighborhood while they fold the laundry or make dinner. The science doesn’t support the level of derision that parents receive for even minimal uses of screen time. So when the American Academy of Pediatrics (AAP) issued new working group recommendations on screen time last week, I decided to make an exception and talk about the subject one more time.

I like to refer to subjects like exclusive breastfeeding, screen time, and the amount of time parents spend with their kids as “Modern Mom Guilt.” I think I and just about every other interested parent in America breathed a sigh of relief when the AAP let us know that screen time was one less thing parents had to feel guilty about.

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Categories: Ages + Stages, Mental, Emotional, + Behavioral Health, School-Aged Children, Science 101 + Mythbusting, Toddlers + Preschoolers

Transparenting Pink Boys and Blue Girls

By September 21, 2015 No Comments
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You may remember last year when Transparent, an Amazon original comedy-drama series took home five Emmys at the 67th Emmy Awards, which was a big leap for the subject matter into the public eye – and yet another step toward positive, wide-spread visibility for a subject that’s still unfamiliar to people. The series depicts the process that a father of three adult children must undergo as he comes out to his family about his true transgender identity. Like Caitlin Jenner, Laverne Cox and Chaz Bono, the lead character of Transparent brings the experience to greater understanding. What is perhaps less known is that awareness of being transgender can often emerge as a young child, and the stories like those of Jeffrey Tambor’s character (pictured right) don’t always shed light on the fact that from early childhood, many transgender adults have struggled to be out and open about who they are.

For most parents, upon hearing the words “it’s a boy,” or “it’s a girl,” conjure up a picture of how their child will look, what the child will wear, toys they will like, and who they will marry.  All of these ideas are based on the assumption— and the expectation of most parents — that their children will be heterosexual and gender-conforming.

What happens, then, when our children do not follow the path we imagined when they came into our lives as babies?  Do we give our children space to express themselves without judgment, for example, when our sons want to wear pink converse sneakers or our daughters want to wear a necktie?  Many parents like myself absolutely want to expand gender roles for our children, and consider ourselves feminist, progressive, open-minded, etc.  Truth be told, however, when we see behaviors in our children that we associate with being gay, lesbian, bisexual or transgender, we are often uncomfortable and may, out of fear or worry, say or do things to inhibit our children from being who they truly are.

It’s important to understand the meaning of sexual orientation and gender identity — very different aspects of who we are as humans —  are often conflated, and both tied up in conversations we have when talking about children who are not gender-conforming.

Sexual orientation is quite simply who we are physically/romantically attracted to; some people are solely attracted to the opposite sex, some to the same sex, and others experience attraction to both/all genders.  It is believed that sexual orientation is wired in us from birth and that by middle school a child is aware of this aspect of themselves regardless of whether they have acted on any feelings or shared them with anyone.

Gender identity is one’s innermost sense of being either male or female, or in some cases, both or neither. Gender identity is believed to be established by age 4, though for some children—and adults, coming out as transgender may be delayed based on fear of rejection, lack of safety, or simply not understanding their experience and not having a place to openly explore their feelings.

For most children, their assigned sex at birth (“it’s a girl!” or “it’s a boy!”) will match their gender identity. This is referred to as being cisgender (cis is pronounced like the “sis” in the word “sister”).  But for some children, they will have a profound sense of being a gender other than the one assigned at birth. For example, a three-year-old child assigned male at birth but who feels like a girl and wants to be girl, and is insistent, persistent, and consistent about this feeling, may in fact be transgender.  And for a growing number of children—teens in particular, there is a fluid, or non-binary gender identity that can include wearing a variety of “girls and boys” clothing, appearing androgynous, using the pronoun “they,” and other ways of eschewing the limitations or inaccuracy of either a male or female identity.

We often hear the term “gender non-conforming” when referring to children who behave in ways that are not consistent with more traditional gender norms or gender roles.  This might include girls who are tomboys or boys who prefer to play with dolls.

What should we do as parents if our children are among those who express themselves in ways that suggest that might be LGB, or T (Lesbian, Gay, Bisexual or Transgender)?

The most important thing is to give children the room they need to explore who they are, and to express themselves openly and freely.  There is no way for us to know what any of these behaviors might mean with regard to sexual orientation or gender identity. Many children who enjoy gender expansive (gender non-conforming) behavior do not experience discord with their assigned sex at birth, and are not destined to be same-sex attracted.  But some will follow that path and, as parents there are things we can do from early on to create a safe, accepting environment if our children are in fact LGBT identified at some point in their lives.

How do we support our children in this process, no matter what path they end up on? We can avoid “gender policing,” which often shames our kids and shuts down their need to express themselves with clothing, toys, hobbies, etc.

Sometimes by habit, or reflex, we might say to our son who is eyeballing a play kitchen at Toys R Us, “those are for girls,” or when our daughter wants to play touch football with the neighborhood boys instead of encouraging her, we caution her with “that’s too rough for girls.”

I’m sure many of us say things that reinforce rigid gender roles without realizing we are doing it, and simply paying attention can reap dramatic changes in the level of comfort our children have to simply be who they are.  What we know about LGBT children—teens in particular, is that family support is the most critical factor in their overall well-begin.  Too many LGBT youth are rejected when they “come out,” and it’s that rejection that shatters the foundation of trust and security and sets up our kids to struggle emotionally, academically, and socially.  Believe me, our children are listening closely to what we say in regard to sexual orientation and gender identity, and what they hear will be their clues for whether or not they can trust us and turn to us when or if they need to share about those parts of who they are.

If you are a parent who believes your child may be transgender, based on the criteria that they assert their gender on a persistent, consistent, and insistent basis, there are many online resources to help you better understand “gender dysphoria,” the clinical diagnosis that applies to these children and to find highly experienced medical providers and mental health professionals in your area to help support them.

Transgender Actor Laverne Cox on the cover of Time Magazine (courtesy: Time.com)

Transgender Actor Laverne Cox on the cover of Time Magazine (courtesy: Time.com)

Transgender individuals are gaining visibility in the media with the popularity of shows like Transparent, as mentioned above, Orange is the New Black (featuring Laverne Cox, pictured left), and the widely-publicized transition of Caitlyn Jenner, to name a few. Jeffery Tambor, who won for best actor for the lead role in Transparent recognized the significance of his win by dedicating to the transgender community, saying, “thanks for your patience, thank you for your courage, thank you for your stories, thank you for your inspiration, thank you for letting us be part of the change.”

Likewise, there are many emerging voices of parents of transgender children who are now advocating for their children at school and in the broader community; many of their stories are told in books, in videos, and on their personal blogs and websites. The voices are out there – and I believe connecting with other parents of transgender children is incredibly empowering and certainly the best path toward being educated and informed about the best ways to support and take care of your children.

 

 

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Categories: Mental, Emotional, + Behavioral Health, Policy, Politics, + Pop Health

How to Survive When Your Toddler Throws A Tantrum in Public

By September 14, 2015 No Comments
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 Let’s face it: everyone is lucky if they survive the toddler years, parents and toddlers included. We’ve been lucky in that our son’s temperament is rather laid back, but we’ve had our fair share of breakdowns in the grocery store and family dinners out interrupted by unexplained temper tantrums.

One epic tantrum happened in our local grocery store while my husband was out of town for a week and I was about 25 weeks pregnant with our second baby. We needed groceries, leaving without food was not an option, and my son had a massive breakdown. Arms and legs flailing, and screaming. Getting down to his level and talking to him didn’t help, distraction didn’t help, he was unhappy and would not be pacified. I have to say part of me was impressed by the meltdown as it was sustained. That kid had stamina! It went on for about 10 minutes as I threw the last groceries into our cart and rushed to the checkout aisle.

As I rushed to check out, I apologized to everyone around me. I remembered judging mothers before I had kids, so I expected judgmental looks and whispers from passersby of “can’t she control her child?” Here we are, I thought to myself, karma has won, the shoe is on the other foot. I totally deserved this very public tantrum and any judgment I received from others in the store. But instead nearly everyone looked at me with pity and offered me the reassuring words, “don’t worry about it, we’ve all been there.” Thank goodness for caring strangers!

That helped me feel better about myself in the moment but didn’t help me prevent or stop the meltdown. So why do toddlers have tantrums in the first place and what can you do when a tantrum happens in public?

Unfortunately, temper tantrums are a normal and important part of toddlerhood. Yes, ear piercing screams and flailing about because you won’t let your two-year-old play with a knife is perfectly normal. Frustrating for both of you, but completely normal.

What causes tantrums is actually highly dependent on biology.  Worry not, your child isn’t having a breakdown in Target because you’re a bad parent or because you use the wrong parenting philosophy.  Despite what some claim, the children of Attachment Parents and Tiger Moms have tantrums too, because it’s normal and natural. While toddlers have developed some level of autonomy through walking and basic language skills, they haven’t developed two important cognitive factors: 1. The necessary language skills to express themselves and; 2. self-control.

In the case of the first, it’s important to know all communication requires both receptive and expressive language. Receptive language is the language that we understand, i.e: When someone says “cup,” we understand it means a thing that holds liquid and that we drink out of. Expressive language is the ability to communicate to others, i.e. to say to someone, “I want the cup” and to refer accurately to a cup (instead of saying “cup” but meaning “plate”).

Receptive language develops first, with expressive language playing catch up. Unfortunately for toddlers this means that they often understand much more than they can express and that, of course, leads to frustration. Alternatively, sometimes they don’t have either the receptive or expressive language to understand or express how they feel and that too leads to frustration.  Essentially, it’s really frustrating to be a toddler.

As a comparison, we’ve all had the experience of needing to communicate with someone when there’s a language barrier. It could have been at work, or in your personal life but we’ve all encountered someone who speaks a different language from us who we need to communicate with but can’t, or struggle to.  It’s usually a really frustrating experience, even as an adult.

prefrontal-cortex NIH

Image of the brain and prefrontal cortex, c/o NIH

Essentially the same thing is happening with your toddler when they’re struggling to communicate with you. Unfortunately for them they haven’t yet developed the all important skill of self-control, which prevents most of us from breaking into an uncontrollable rage when we get frustrated. The development of self-control is linked to the part of the brain that also regulates emotion. This part of the brain is called the prefrontal cortex and it sits, appropriately enough, at the front of the brain. Unfortunately for everyone the prefrontal cortex is one of the last parts of the brain to fully develop. In fact, it’s not considered to be fully developed until age 12, with higher executive level functions not truly developing until we’re in our 20s.

As adults we’re used to being told “no” and for 90% of us we don’t fly off the handle when we hear the word. We might not be happy about it, it may frustrate us, but we don’t scream, yell and throw ourselves on the ground. This is because our prefrontal cortex has developed appropriately and we’re able to regulate our emotions and our reactions. For the other 10%, we’ve all encountered them in airports, on the subway and at customer service counters, and they’re usually acting like toddlers having a meltdown when receiving information they don’t like.

So take comfort fellow parents, if your child has a tantrum in public or otherwise, it’s not because you’re doing parenting wrong or have ascribed to the wrong parenting philosophy. It’s biology, pure and simple, and there’s nothing you can do to skip this developmental stage.

So now that you’re breathing a sigh of relief that your toddler’s public tantrum isn’t your fault, how are you supposed to handle it when the inevitable happens?  How do you manage your tiny, otherwise lovable ball of abject rage in the best way possible for them and for the sanity of those around you?

The American Academy of Pediatrics has great recommendations for handling tantrums and we use them in our home.  I would highly recommend you check them out, but I’ve summarized and organized them below as well.

Generally:

  • Catch Them Being Good: Praise is a powerful tool for any of us, but especially for children. Day-to-day when you catch your child being well-behaved, being patient and gentle, let them know you noticed and give them praise for behaving so well. This can help incentivize good behavior.
  • Zero Tolerance: Have a zero tolerance behavior for things like hitting, biting, kicking or throwing. Make sure your child knows that behavior isn’t acceptable as soon as it happens.
One of the "To Go Kits" Leslie and her husband keep available when they know their son is likely to have a tantrum. We use small toys, one with wheels, one soft, a book and triangle crayons. Triangle crayons are life savers, no rolling off the tables.

One of the “Go Kits” Leslie and her husband keep available when they know their son is likely to have a tantrum. Each has a toy with wheels, a soft toy, a small book and triangle crayons. Triangle crayons are life savers, no rolling off the tables.

Before heading out:

  • Set yourself up for Success: If you know your child is more likely to have a tantrum when they’re hungry or tired, before you leave make sure they’re rested and have eaten. Or pack a snack. We know our son throws tantrums when he gets bored, so we created these little “go packs” that we take with us whenever we’re heading to a restaurant, doctor’s office or any other place we know he’ll have to sit for a while. Pro tip: triangle crayons, they don’t roll away.
  • Know Your Child’s Limits: Just like adults, kids have good days and bad days. If you know your child is having “an off day” put off running your errand if you can.

During a Tantrum:

  • Distract: If you can, change rooms or locations, sing a song, offer up a toy or point out something in the area that they might find interesting. If you’re in a store, leave your cart at customer service and take your child outside for a change of venue.
  • Offer Alternatives: If possible, give your child some measure of control over the situation but offer them a choice of alternatives. For example, “we can’t go to Nana’s house today, but we can go to the park or to your friend’s house after this, which would you like to do?”
  • Pick and Choose Your Battles: We all know that consistency is best, but some days it’s a case of survival. It’s OK to compromise or give-in a little if you’re in a situation where you know you can’t leave (ie: doctor’s office) and you know your child has reached their limit.

When All Else Fails:

  • It’s OK to Walk Away: Sometimes you have to pack up your things (toddler included!), and go home. Consider the errand or the event a wash and go home to nurse your wounds. If the tantrum happens at home, it’s also OK to make sure your child is in a safe place (preferably with another trusted adult) and take a 10-minute sanity break. I have had to do both of these things more than once.

On the bright side, temper tantrums are a temporary phase, even though it doesn’t seem like it at the time. Most children outgrow regular tantrums by the time they’re three or four, with the odd tantrum remaining through ages five and six. In the meantime, may the odds be ever in your favor.

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Categories: Ages + Stages, Mental, Emotional, + Behavioral Health, Toddlers + Preschoolers

How to Help Your Child Learn Self-Control

By August 31, 2015 2 Comments
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Helping your toddler or your child of any age learn self-control can be very difficult because in order to be successful, you must also have good self-control. As a tired parent, this is not always easy. And so my first advice to you, different from all of the other advice I’ve seen on disciplining children, is to look after yourself as much as you can to make sure that you are as ready as you can be for the challenges of parenting.

A toddler sees himself or herself as a very powerful human being. He or she is moving on their own, can eat by themselves, is learning to manage bodily functions and is modelling everything you do. This developmental period is the time to be a good model and is the ideal time to guide the process of learning self-control.

To start with the most basic advice on discipline, here is a simple page of excellent suggestions that you can print out, from the website of the Canadian Pediatric Society.  If you are looking for something with a bit more theory, this guide from the National Institutes for Health in the United States is very good.

With this advice in hand, let me offer you the biggest lesson that I learned about child discipline.

This lesson fixed in my mind after seeing my oldest child through her toddler years. What I learned is that our most basic activities, like eating and sleeping or active times, all follow a routine that becomes internally set. This is especially true of small children. In my experience, parents who do not follow their young children’s inner rhythms can expect trouble. A hungry or tired child is more likely to lose self-control, just as their tired or stressed parent does. It’s always best to be respectful of those needs and the payoff of recognizing and respecting them is that a child can more quickly develop self-control in other areas.

Another thing to remember is that very young children do not understand long, verbal explanations, so say things simply: “No, that’s hot!” You want your child to realize when you’re saying that something is dangerous, to stop immediately. If they do not stop, you will have to intervene to physically keep them safe. If they do stop, praise them – be sure they understand that they’ve done the correct thing.

You must also do your best to be consistent. If your child cannot clearly understand from you the best way to act, he or she will not be able to learn how to act. It is in this situation that one observes a child testing the limits of acceptable behavior. While some children test the limits regardless, not knowing the limits makes this far more likely.

The follow-up to consistency is following through. Following through is very difficult, especially in the grocery store line with all eyes on your screaming toddler who wants a treat. The first thing to try is to divert the child’s attention – for example, see if they can help you to unload the cart. You can remind them that there is a healthier treat at home. But it may just be that you will have to hold a screaming child to ensure that they don’t harm themselves and wait until they have settled down to pay for your groceries.

Most people in the store will be very sympathetic and even helpful, a reinforcement to your lesson that bad behavior is not acceptable. Another thing I remember when this happened to me was that all the other small children nearby managed to be “perfect” while my child was misbehaving. This was no accident since most children want to behave well and nothing focuses them better than someone their own age not managing their own behavior. Grocery store lines can also set the stage for an excellent opportunity to tell them how proud you are of them. In fact, say this whenever it applies – we can all use extra reminders that we are learning well.

Every parent has heard about time-outs and there is no more effective method to remind a child that self-control is absolutely necessary. Find a safe place for these and be prepared to stay with a very young child while they calm down. Many people use a timer but it is important that a child understand that he or she is taking the time to settle down and be ready to apologize for what they have done. If it takes resetting the timer several times for a child to settle, then reset the timer. A child who has settled will likely be sorry for what has happened and that is the sign that they are ready to finish a time out.

Adults modelling good self-control helps children learn good self-control as well - photo: K. Kruckenberg

Adults modelling good self-control helps children learn good self-control as well – photo: K. Kruckenberg

I want to end back where I began and remind you how important your behavior modelling is in helping your child to learn self-control. If you are tired and stressed and not managing your own actions well, your child will notice. At the very least, their confusion about your distress will make it harder for them to know how to act. Explain to the extent that you can, “I’m worried (sad, upset, etc.) today.” Give yourself an easier time and be mindful of what might help you manage yourself. Find some things that you love to do with your child that you both enjoy and do those things.

We do not really teach our children self-control, we help them to learn. Every child deserves a parent who loves them enough to care that they learn this important lesson and, some days, you both deserve a day off to enjoy each other.

You can read more of Dr. Gail Beck’s work on The Scientific Parent here.

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Categories: Ages + Stages, Mental, Emotional, + Behavioral Health, Toddlers + Preschoolers

Talking about Death with Children, Starting with Pets

By August 11, 2015 1 Comment
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One of our readers wrote in looking for advice. She bought a small pet for her three-year-old daughter and the pet recently died. She’s worried that three years old is too young to talk about death and that it might scare her daughter. So we turned to expert Dr. David Rettew, a pediatric psychiatrist, for advice.

Death is a topic that is difficult for everyone but can be especially tough and confusing for children. The finality of death can be a particularly difficult concept to grasp, particularly for preschool-age and younger children.  Even for older children, a true understanding of death doesn’t just appear one day, but becomes gradually appreciated over time.

For children fortunate enough to be spared the early loss of a parent, friend, or loved one, the first real exposure to death often comes with a pet.  While not wanting to minimize how truly painful this can be for some kids, the event can provide an opportunity to introduce the idea of death without it being overwhelming.

In talking about the death of a pet with a younger child, it may be important to stress that death means that the pet isn’t not going to move in the future or “wake up.”  Another good aspect to cover is blame, as a child may mistakenly believe that forgetting to feed a fish one day or mistakenly tripping on the dog was the reason a pet died.  For those who have religious beliefs about death and an afterlife, it can be very comforting for children to hear those thoughts as well.  Perhaps most importantly, listen to your child and show that you are able to hear their questions and concerns.

A couple minor tips about language.  Even for younger children, it is often a good idea to use the word “dead” rather than something that sounds softer like “sleeping.”  The reason for this is that children think quite literally and may begin to associate sleeping with death.  Similarly, a pet or relative with a terminal illness shouldn’t be described simply as “sick” as it again may cause a child to worry that getting a cold may lead to dying. Phrases like “serious disease” or a “body no longer working” might help make establish that difference. If you’ve been through this discussion already and haven’t used all this type of terminology, however, don’t worry.  Most kids develop just fine with our well-intentioned but sometimes clumsy ways of explaining things to them.

Many parents naturally get somewhat emotional themselves in these discussions.  That’s fine and it is healthy for children to see that adults can show intense emotion and still remain intact.  At the same time, children can get overwhelmed and scared around adults who are extremely distressed.

When you do have this discussion, be open and ready for some pretty tough questions.  Are you going to die too someday?  Am I?  In answering these questions, a good general rule is to be a reassuring as you can without being dishonest.  For example, “everybody dies someday, but I’m expecting to be right here with you for a long long time.” Of course, probably the most common question after the death of a pet is – can I get another one?

One idea that can be helpful is to suggest that the family have a small ceremony for the pet.  This can be a nice developmental step in helping your child cope with death and loss. Other kids may want to draw a picture or create some kind of memorial.  If you child isn’t interested in any of those things, however, don’t push it.  People cope with loss in many different ways that can be healthy – if he or she is content with flushing a dead goldfish down the toilet, it is not a sign of a future serial killer. For example, after the funeral of my own father when I was 18 years old, my brother and I just built a bookshelf together for hours.  We had  never done that before nor have we since.

The question of children attending the funerals of relatives is another one that frequently arises.  While the answer obviously depends on many things, I would not be in a rush to take young children to funerals, especially for more distant relations.  If cultural or societal norms encourage this, then likely most children will take comfort in these customs.  Funerals may also be important for children who have lost someone close to them, as mentioned in the ceremony discussion above. In other situations, however, young children may be a distraction to other mourners.

There is no single “correct” way to have these difficult but important interactions with children.  Being thoughtful, available, reassuring, and honest, however, can help youngsters begin to cope with this painful but inevitable part of life.

Additional Resources:


 

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Categories: Ages + Stages, Mental, Emotional, + Behavioral Health, School-Aged Children, Toddlers + Preschoolers, Tweens + Teens

When Can Your Child Ask for Birth Control Without Your Consent + Other Uncomfortable Issues

By July 20, 2015 No Comments
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As parents we’re used to knowing every detail of our kids’ lives. We have video baby monitors in their rooms, their clothing can track their breathing and temperature and daycares and sitters leave us detailed written records of their days when we’re not there. Sometimes it’s hard for us to tell when our kids deserve the right to privacy and when they’re able to make certain decisions on their own.

The issue of a child’s right to autonomy – the right to make decisions about one’s own healthcare – is a common, but messy, topic in health care. We see this most often in issues of reproductive health, for example, when a minor seeks a prescription for birth control or access to an abortion without the parents’ knowledge.

The issue of a child’s medical autonomy raises many ethical questions, all of which tend to make parents uncomfortable. Recently, this notion came up again in response to a post on Reddit, in which a mother, who is opposed to vaccines and did not vaccinate any of her children, relates how she discovered her eldest daughter got herself vaccinated in secret, much to the mother’s chagrin. The mother asks if she can take any legal action against the doctor who vaccinated her daughter without her knowledge.

A screen capture of the original question posed on Reddit, which has since been removed by the author.

A screen capture of the original question posed on Reddit, which has since been removed by the author.

The July 8, 2015 post to the legal advice subreddit was eventually removed, but not before garnering a robust response. Quite a few commenters pointed out that given the girl’s age (16 years), she is fully entitled to make her own health care decisions without her parents’ consent. For those who support vaccines, it’s a great story: a teenage act of rebellion where the teen is the smart one, taking her health into her own hands.

Before we go on, I want to address that there is some question as to whether this story is actually true or not. Some details cast doubt on it, such as the idea of the girl paying for any of the vaccines with her babysitting money as Canada has universal healthcare, which covers all routine vaccinations. While some private clinics would charge for a vaccine, they are uncommon, and many of the nurses and doctors staffing a walk-in clinic are still covered by the Ontario Health Insurance Plan. None of this means it did not happen, but there are reasons to doubt and no means of verifying the elements of the story.

Whether the story is true or not, it brings up an important question: do the parents have a right to their daughter’s medical records? Do they have a right to legal action against the clinics for vaccinating their daughter without their consent? Do the parents’ rights supersede their daughter’s right to privacy and autonomy over her own healthcare?

Capacity to consent is, in many locations, not so much a matter of ability as it is of arbitrary age cut-offs set by law. For instance, in the United States, as far as the law is concerned, you are incapable of safely operating a car unsupervised until you are 16. Only when you reach 18 are you considered an adult, capable of making your own decisions and even altering how our country functions (via voting). But you cannot make decisions, legally, about drinking alcoholic beverages until you are 21 years old, despite the fact that, in all other regards, you are legally an adult.
As far as the legal question in the Reddit story goes, per Ontario law, anyone who is at least 16 years old has guaranteed medical autonomy, barring any conditions or disorders that impair their decision-making capacity. That means that as soon as a child turns 16, they can make their own medical decisions and their medical records are a private matter between the child and their doctor. The mother in the story has no legal right to view her daughter’s records nor to take action against the clinics or the provincial Department of Public Health for complying with her daughter’s wishes.

But what if she were 15 years old? Would her parents have a right then? Not necessarily.

While Ontario law guarantees autonomy once a person reaches 16 years of age, the province is one of several that recognizes that the ability to make medical decisions for oneself is not a simple matter of age. They employ a “mature minor” standard in that there is no statutory minimum age required for a child to consent to medical treatment on their own. If, in the physician’s judgment, the child understands the nature and consequences of their decision, then they are capable of making the choice for themselves, without any other input from the parents. Before her parents would be able to obtain the medical records relating to her autonomous decision or to take action against the clinics, her parents would need to challenge her capacity as a mature minor in court. In short, they would need to demonstrate that she did not understand the nature or consequences of her decision and that she is therefore unfit to make her own medical decisions.

But what about the ethical angle? Regardless of what the law says, should a parent have unfettered control over their child’s healthcare decisions? Should a child be considered completely autonomous and allowed to make decisions without the consent of their parents? From an ethical perspective, the answer to both questions would tend toward “no”, though more realistically, the answer is, “it depends”.

Some research notes that adolescents are capable of making informed medical decisions, and able to understand the consequences of their decisions, by the time they are 14 years old. Other research argues that people are not fully cognitively developed until they are 21 years old and can’t truly understand consequences.

Obviously, there is variation from individual to individual, and from situation to situation. A child may be capable of an informed medical choice at a young age, where they are free of peer (or parental) influence and the consequences are limited in severity. The same child may be incapable of making a medical decision for themselves when they are under the strong influence of friends or their parents, or where the outcomes are of such a great magnitude that the child is incapable of fully understanding. Whether a child is mature enough to make their own medical decisions, whether to accept or refuse treatment, depends on the child and the situation.
If the child can demonstrate that they understand, that they truly comprehend their situation and the options available, then from an ethical standpoint, they ought to be able to give or refuse consent, without the intervention of their parents. They are individuals in their own right, and as such are deserving of respect as an individual. They are not objects owned by their parents. They are not chattel for the parents to do with as they please. They are individual human beings.

In an ideal world, parents and their children would make medical decisions together, and when the child is mature enough, whether as early as 14 or not until they are legally adults at 18, decision making moves into their hands. It may be difficult for parents to accept that their children are growing up, that their kids do not need them anymore. And it can be even harder for some parents to view their children as individuals capable of making their own decisions rather than property, to put aside their own desires and beliefs in deference to what is objectively best for their child.

But no matter what age a child begins deciding for themselves, the parent does not have an absolute right over their child. When it comes to medical decisions, the parent has an obligation to do what is in the best interests of their child, even if that decision is at odds with the parent’s wishes, as is the case with vaccines and parents opposed to vaccination. Likewise, within the parent-child-doctor relationship, the doctor’s duty is to the child, not to the parents.

Unfortunately, there is no hard and fast rule, no clear cutoff point at which we can say, “This person is now capable of making informed medical decisions on their own.” It is a complex issue that is very situation-dependent. But at the very least, we can respect that parents do not own their children, no matter what misguided Kentucky politicians might say. Parents are not free to do with their children as they please, because children are not property. They are not owned. Children have rights, too. That includes the right to protect themselves when their parents fail to do so. – Edited by Leslie Waghorn

– A version of this post originally appeared on Harpocrates Speaks

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Categories: Ages + Stages, Policy, Politics, + Pop Health, Tweens + Teens

The Kids Are Alright. Really.

By July 15, 2015 No Comments
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 For decades, children have been born to or adopted by same-sex couples. Before the advent of legal marriage beginning 10 years ago in Massachusetts, many same-sex couples built families on a rickety legal foundation and by careful navigation of adoption agencies, fertility clinics, supportive or unsupportive family members, and limited social acceptance of our “alternative” families. Why would so many same-sex couples—as well as single LGBT people, choose this often complicated and stressful path to parenthood? It’s simple: our desire to be parents and to experience the life-altering journey of raising a child is greater than our fear of the backlash of bias, bad attitudes, and outright discrimination that so many of our families have endured.

While the recent SCOTUS ruling changes the legal landscape for same-sex parents, it does not erase the myths and misperceptions about our families. Some of these myths are veiled in “concerns for the children,” for example the worry that our children are more likely to be gay, lesbian or bisexual, or that they will experience higher levels of bullying, confusion about gender roles, or somehow end up unhappy. We appreciate the concern for our children – we are concerned about them too, but our concerns are those more typical of all parents – keeping them safe at the playground, helping them make friends easily, providing them with good teachers, and teaching them to be kind and generous.

(excerpt): Some of these myths are veiled in “concerns for the children,” for example the worry that our children are more likely to be gay, lesbian or bisexual, or that they will experience higher levels of bullying, confusion about gender roles, or somehow end up unhappy.

Having two moms or two dads does no harm to children; what does harm them, however, is the homophobia and bullying which they can sometimes face. To date, thirty years of peer-reviewed social science research concludes that children raised by lesbian and gay parents do just as well in key areas of development – social relationships, emotional well-being, academic performance, and connection to family – as do children raised by heterosexual parents.

Yet, with all of this research along with hundreds of thousands of thriving children with same-sex parents living among us, there still persists the belief that children do best with a married mother and father, and that children lose something if they are raised in other family structures.

Let me put to rest some of the myths and misinformation that, in fact, are the very thing that chip away at our children’s optimal well-being.

My two daughters have two moms. We are intentional parents—our children were wanted and planned; in fact, we joke that our children are “more processed than Velveeta cheese.” We did not have the option of getting pregnant the old fashioned way—we had to find a donor, track ovulation, time the inseminations just right, lay out a lot of money, and put legal documents in place (this was well before marriage equality in Maryland, where we live); whether pursuing adoption or assisted reproduction, our paths to building families takes time, money, and will. I am well aware that many heterosexual couples and single people face fertility and financial challenges as well, which I am in no way diminishing. I’m simply making the point that LGBT people only have alternative options to consider from day one of their family planning experience. The foundation for our families is strong in that our children are wanted, planned, and our intention to parent is clear. I would think this is a foundation we would ideally want for all of our children, regardless of family structure; when families are ready, willing and able to parent to the best of their ability. In these scenarios, children do better, getting the attention, nurturing, and support they need in order to thrive.

Ellen and her family

Ellen and her family

It is a myth that our children are more likely to be gay or lesbian, or confused about their gender. If you ask a roomful of gay people whether they have gay parents, typically not one person will raise their hand. In other words, it’s statistically more likely that children who are lesbian, gay or bisexual will be born to straight parents, because straight individuals are a higher percentage of the total population. Sure, some LGBT parents will have LGBT kids, but not at any higher a rate than those raised by non-LGBT parents. Research on adolescents and young adults with LGBT parents suggests that those who are same-sex attracted feel safer “coming out” to their family, which is good for their mental health. On the contrary, many LGBT children and teens are terrified to come out or express these feelings to their straight parents for fear of being rejected. In terms of child well-being, it is essential that parents are supportive and accepting of their LGBT children even if it’s hard for them personally, since the impact of parental rejection can be as severe, but not limited to suicide. Sexual orientation—who you are attracted to—is wired and can’t be changed, and children with same-sex parents have the same statistical potential as all children of being something other than heterosexual.

Those same studies that found that having same-sex parents does not increase a child’s likelihood of being gay also found that having same-sex parents does not cause gender confusion.  There are all types of modern families which are breaking traditional gender roles, including those with “stay at home” dads and working mothers, ones in which the mother and father more equally divide household chores according to what they enjoy, versus what a 1950s version of Good Housekeeping magazine endorses. Some men cook, some women mow the lawn; it is good for children to see equity in household management and the full range of what is possible for girls and boys to do rather than live with prescriptive, limiting gender expectations. Our sons and daughters will see that there are many different ways to be men or women, that there are no hard and fast rules about how they parent or how they help around the house. They are not confused about gender roles– they are simply learning the expansive nature of what it means to be male or female in a modern society.

The most important myth to counter, in my mind, is that our children will be unhappy. To my earlier point, the greatest harm to our children’s emotional well-being comes from bias and discrimination toward our families. What children need is one, two, or more parents or guardians who are consistent caregivers, unconditionally supportive, and invested in helping them become the best people they can be. Whether those parents are straight, gay, transgender, rich, poor, or married has little to do with their capacity to be good parents. When children face discrimination, bullying, or rejection, they are more likely to be depressed, anxious, and to struggle with their emotional well-being. There is no evidence in any research on LGBT families to support this notion that our children will suffer, but there is research that shows the impact of trauma on children, and it’s the trauma of homophobia and rejection on the part of people outside of our families that is of greatest concern to us, and to our children.

My daughters have two loving parents, an extended support network of family, friends and neighbors, and are being raised in a community that is generally LGBT-inclusive and where there are many other visible families headed by same-sex couples. They know their family structure is in the minority and that there are still people out there who don’t like the idea of two men or two women raising children, and they will be the first to tell you that they are all right—beyond all right, in fact. For too many of our families across the country, feeling isolated and marginalized on the soccer field, at the PTA meeting, or at the local playground is still a reality–marriage equality or not. All of us can have a role in creating a community that embraces family diversity, that recognizes the many ways in which my family is like so many others—doing the best we can to raise happy, healthy children. Letting go of myths and getting to know LGBT parents and their children is the best thing you can do to support our families and your own – Edited by Julia Bennett + Leslie Waghorn

 

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Categories: Mental, Emotional, + Behavioral Health, Policy, Politics, + Pop Health