This is the only english book that I ever finish. Haha.. :))
The reason I pick it is simple I need to know the correct way to raise my kids and it's the only book look thin to me.. haha.. :))
I think the book really worth to read except it got many repetitive stuff.. :p Perhap the author want to reassure the reader remember the brief introduction and repeat again when go to detail..
The whole book I think the most useful to me is chapter 8. It cover a lot of good information..
I type the whole chapter here.. Still have some incomplete data.. I have not complete it some are still in point form I will update bit by bit.. hehe.. no time and I only hv 10 fingers k.. :p
Chapter 8 Growing up problems
Children progress as if they take two steps forward and one step back. There will be periods of emotional disturbance at some stage. Often these are transient and are not in themselves a cause for concern.
Studies show that 2/3 of the preschoolers will continue to have difficulties at pre-adolescence and adolescence. It is thus important for parents to recognize the problem early and seek appropriate help. The attitude of parents is important. They must recognize that they have to work with their children to get the behavior changed. Parents can also assess the child’s problem by observing, listening and trying to empathize with the child.
When does the problem become a disorder?
- The persistence of a behavior. An emotional disorder may be suspected if a child is always full of fears – no sooner does one disappear that another takes it place.
- The extent of disturbance.
- The intensity of particular behavior. Symptoms are severe enough to cause significant distress in the child or the people caring for him.
- Age of a child. A young child may often show tantrums at 2 years but if these tantrums occur in a teenager, a disorder may be present.
- Intelligence of a child. A normal child who spits at people and screams for no reason may have an illness but such behavior may also be common in a child who is dull.
- Temperament of a child. Children who show aggression in all their actions from young may have a mental problem. A quiet and courteous child who suddenly lashes out at people may also have a mental disorder.
- The family background. Children from families who resolve problem through violent means will react in the same way.
- Behavior patterns. Does the behavior interfere with the child’s development and daily activities? Besides judging whether the behavior is unusual and abnormal, observe whether it affects his day to day living, causing him to suffer, be tearful, fearful and having frequent nightmares.
The First Year:
1) Feeding.
Colic is a problem in infancy in 5-15% can last up to 5 months. There is some indication of pain by the fussing and irritable baby and he may have occasional flatulence.
Parent should not blame themselves or be alarmed if their child refuses to eat. If the child is generally well nourished and healthy, the problem may be in the eating habits: irregular meal means that a child cannot settle on a fixed routine.
This can result in a fussy and difficult child who will demand food when he is hungry. Eating in front of the tv set distracts the child from the meal itself. Portions should be appropriate for the child’s age and size.
Variety of food is very important. Recommend that the child be allowed to have the same meals as adults once he is able to do so. Keep in mind that young children cannot eat large portions or food that is difficult to swallow.
With younger children, especially those under a year old, parents have to be more cautious. Sudden loss of appetite may be due to illness. Look out for signs such as mild fever, vomiting or diarrhoea. Fits are serious and should be seen by a doctor for assessment even though it may be due to a fever. If there is a change in the alertness of the child, do not hesitate to seek medical attention.
Persistent poor appetite may indicate medical problems. It is recommended that parents seek the advice of their family doc in situations when they are unsure. If the child is not putting on weight despite eating well, parents should also check for medical causes.
Emotional upset rarely affecting child’s feeding unless under abused or live in stressful environment. Parents must be aware that children also need praise and encouragement to eat and they can do this by sharing mealtimes with their young child.
There needs to be a balance between being strict(“if you don’t finish your food, we will take it away”) and giving praise to a young child who needs coaxing and encouragement(“you are such a good boy for eating your food”). Generally, very young children need some degree of coaxing while order children can handle certain rules with regards to eating.
2) Obesity.
Study showed that 36% of overweight babies grew into overweight adults. Obesity in young children has multiple causes. Some are rare medical and genetic causes but the most common is excessive food intake.
Helping the obese preschooler:
o Parents must recognize the problem. Don’t say the child is just chubby and cute.
o Rule out medical causes which are rare.
o Change the diet to include less tidbits and fattening foods like sweets and chocolates.
o Regulate the pace of eating so that the child will be able to feel full and stop eating.
o Encourage exercise.
o Monitor feeding and activity through the use of checklists.
o Give tokens, stars or points for reinforcing healthy eating habits.
Stimulus control intervention has been effective for some children. One example is traffic light diet developed by Epstein and his colleagues. Green foods are those which are low in calories and high in nutritional value, yellow foods are those high in calories but have some nutritional value, while red are foods that have no health benefits and should not be taken.
3) Mother-child boding problems.
The close bond that a child forms with his main caregiver (usually the mother) is the basis for all future relationships. This shown by the normal clinging behavior of the young child and the separation anxiety he feels when the mother is away. It is important to remember that bonding is a two-way process between mother and child.
Situation which make this normal bonding difficult and even absent are:
o The premature child is separated from the mother at birth and needs to be nursed in a clinical environment.
o The child is mentally retarded and unable to respond to the mother.
o The mother is unwell and unable to nurse the newborn infant because of postnatal blues or severe postpartum illness.
o The mother is repulsed and afraid because the child is born with congenital malformations.
The crucial process of forming attachments and bonding takes place when the child is about 3 months to 3 years old. After this age, a greater effort is needed to cultivate deep attachment, although this is not impossible as some late adoptions prove.
4) Sleep disturbances.
Average amount of sleep a child needs:
Age Hours of sleep
Night time Day time
1 week 8.25 8.25
1 month 8.5 7
3 months 10 5
6 months 11 3.25
9 months 12 2
12 months 11.5 2
18 months 11.5 1.75
2 years 11.5 1.5
3 years 11 1
4 years 11.5 0
5 years 11 0
6 years 10.75 0
Sleep disturbances in young children are common in the tender years and include:
o Difficulty in sleeping
o Waking up frequently
o Nightmares and night terrors
o Sleep-talking, walking
o Bruxism (teeth grinding)
Difficulty in settling to sleep
o Define the sleep problem
Sleep problems are common and not a sign of bad parenting. Remember that even adults occasionally have difficulty falling asleep. There may be a number of reasons why a child does not sleep at an expected time. He may not be tired. For example, he may have had a long afternoon nap or woken up late the morning before. Or he may be overexcited and unable to fall asleep. This is especially so if he had friends over or there was an exciting TV show. He could be staying up for his parents who work late. He could also be fearful of going to sleep and being separated from his mother, or be frightened by his parents quarrelling.
o Establish the sleep pattern of your child
Check how long he sleeps and how long his day is, the length of his nap during the day, when he regularly sleeps and when he actually falls asleep. Check the activities he has before he sleeps, such as watching TV and having a warm bath or a warm drink.
o Develop a sleep routine
A young child who is well rested is more likely to be cheerful and happy, and ready to explore the world every new day. Conversely, a tired child who is irritable and unhappy is more likely to throw tantrums. Develop a routine where he has adequate sleep but not too much during the day. A brief afternoon nap helps the quality of night time sleep. There can be a bedtime ritual such as having a warm glass of milk, reading a bedtime story, being tucked in bed and a goodnight hug and kiss by the parents.
o Deal with cries
The most commonly suggested method is to allow the child to “cry it out”. Both parents must have the resolve to go through with it. Explain to the child that once he in bed, the parents will leave him for the night. Prepare your neighbours because his crying will be intense and get worse, before he finally tires and falls asleep. Some children may cry for one or two hours. The child should not be allowed to leave the bedroom. One way is to have a gate. Parents should busy themselves so that the child’s crying will not upset them. Noise of their activity will also reassure the child that the parents are around. Make periodic checks and gradually increase the interval between the checks.
o Wake up frequently
Children who wake up in the middle of the night are more difficult to handle because parents would be exhausted and tired. We suggest the following method for handling this:
§ Did the child fall asleep easily and then wake up? If this is so check on medical reasons for discomfort, for example, skin problems like eczema or scabies, asthma, or ear infections.
§ Parent can take turns to handle the child.
§ Gently lead the child back to bed. Be with the child until he sleeps before returning to bed yourself.
§ Praise the child in the morning.
Case example: The night bird.
Four year old Jian Kang, an only child was usually asleep by 7.00 pm. One night, the noise of the TV woke him and he was allowed to watch the programme along with his parents because his father worked late and hardly saw him during the day. Subsequently, Jian Kang work up every day at midnight and would not go back to sleep until 5.00 AM. His parents desperately needed a good night’s sleep and came to the clinic for help. Jian Kang’s sleep patterns were changed and the behaviour reinforced because his father played with him initially. His parents were advised to turn off all the lights and stay in bed when he woke up. After several nights, Jian Kang no longer woke up in the middle of the night.
5) Fears.
Frear is defined as a pattern of three reactions to a threatening object or situation: a physical reaction of running away, avoiding or cautious approach; a subjective reaction of crying, screaming and even of terror; and a body reaction of rapid heartbeat, perspiration and hyperventilation. Phobia on the other hand, refers to the same reactions but to objects or situation that pose little danger or threat.
Fear factors for different ages:
Age Common normal fears
Newborn Sudden changes in the environment, loud noises
6 months New situations or objects, for example, a mask
8 months Anxiety amongst strangers
1-2 years Anxiety when separated from caregiver
2 years Fear of the toilet
3 years Fear of animals
2-4 years Fear of imaginary monsters
4 years Fear of the dark
5 years on Fear of going to school (not persistent)
How can parents help the fearful child?
o Parents should consider whether fear protects the child. Obviously a child who cannot swim is afraid of the water. This prevents the child from drowning. A young child’s fear of large unfamiliar creatures is justified because he can neither escape nor depend himself against them.
o Parent should also consider if the fear is commonly encountered one. Fear of snake may need no treatment as the likelihood of encounter one is low unless the child visits the zoo.
o Seek treatment if the child cannot function properly, become very upset and distressed and have large amount of fear in many situations.
o Treatment is done by professionals using behavioural techniques such as desensitization (exposing the child to fear object or situation), modeling, and the use of reinforcement in form of reward.
The Second Year:
1) Toilet training
Many children begin to have some degree of bladder control only after a year old. Most children may be able to indicate the need to pass urine in the day but will not acquire night time dryness till about five years of age.
2) Tantrums
Temper tantrums are commonly occurrence in the second years of life, giving rise to the phrase “terrible two”. Parent must distinguish between control tantrums which are a child’s way of getting what he wants, and frustration tantrums which are expression of his failure to accomplish a task. Control tantrums are best ignored while frustration tantrums should be handled more sensitively. For example, parents can assist the child by making his tasks simpler and easier to accomplish.
3) Eating the inedible
This is a term used to describe the indiscriminate eating of inedible items, from raw potatoes to even stones and lead. This is a normal stage of development. In the first one or two years of life, children have a tendency to put things into their mouths. This has been described as the “Oral” phase of development. Young children should be supervised and not allowed to ingest items that they find. Not only is this unhygienic, it can be dangerous as they may choke on large items.
Mentally retarded children continue this behaviour. Children who are under great anxiety or stress are also prone to this behaviour. For example, they may bite their nails or pull their hair when anxious. This can be treated by teaching the child to handle anxiety and stress a different way.
4) Hair pulling(Trichotillomania)
Trichotillomania is a rare disorder characterized by significant hair loss due to child’s irresistible urge to pull out his hair. This act is usually cauted by mounting tension, followed by a sense of relief or gratification.
In very rare cases, some infants who pull out and eat their hair have been diagnosed with iron deficiency and the symptoms improved when they were given iron supplements. In the young, such behaviour is often temporary. Parents should find ways to stop the habit as it can lead to dangerous condition when hair balls form in the intestinal tract and cause obstruction.
5) Delay in development
This is a common concern with many parents of young children. Today’s parents more aware of their child’s delay in any aspect of development, partly because they are better educated and young children are frequently screened at the polyclinics. The DDST (Developmental screening test) screens children between two weeks and six years of age, and assesses development in four main areas: personal-social functioning, fine motor coordination, language development and gross motor coordination.
The third year:
1) Teeth grinding
Bruxism is a condition seen in almost all children some of the time. If the problem persists, it can cause abnormal and uneven ear of teeth. Medical and emotional causes for bruxism include normal sleep activity, a dental condition known as malocclusion, mental disorders and retardation, and even anxiety. Bruxism is also associated with illnesses and allergies such as sinusitis, hyperthyroidism, epilepsy and meningitis.
Parents can seek dental assessment to exclude malocclusion and assess the abnormal tooth wear, if the condition persists. If no abnormality is present, it is likely that the bruxism will resolve over time. A tooth protecting mouth guard can be worn to prevent further teeth damage. Medication can also be given in severe cases.
2) Development disorders
Children need to interact with other people in order to grow and develop. Their smiles and laughter invite adults to cuddle and play with them. In some children, such interactions do not occur in this expected manner. Instead, the child develops strange habits and poor social and language skills. These characterise pervasive development disorder such as:
- Infantile Autism
- Asperger’s Syndrome
3) Managing pervasive developmental disorders
Managing pervasive development disorders
There may be no cure for pervasive developmental disorders at present but the principles of helping such children lie in several areas:
- Help the child develop in as normal a way as possible.
- Help the child in cognitive development. Many of these children tend to be isolated from their peers. Parents should therefore try to plan periods of meaningful interaction with the child. Because they have problems learning and understanding, such children need to be coached individually at a simple level that suits their development stage. The more severely affected children would probably need special schooling. The lack of initiative and motivation in the child should be handled with structured learning and direct teaching. As these children react badly to failure and tend to give up easily, parents should plan and give them tasks that they can accomplish successfully.
- Help the child in language development. Parents must specially put aside time for uninterrupted play and conversation. Every opportunity for social interaction should be seized upon. Because they lack communication skills, these children have to be taught skills that come naturally to normal children. Parents must focus on communication in all forms, not only speech. Speech training should be continued but if there is little or no speech development, other communication such as sign language can be tried.
- Help the child develop socially. The child may not enjoy interpersonal relationships and responds poorly when approached by other children. Parents can help by providing periods of enforced interaction where their child has to interact with them or others before being allowed to engage in their preferred activity. For example, parents can make autistic child who like to watch wheels of bicycle, play a game of card first. It is very important that the child is not abandon into institutional care as having multiple care-givers will cause more severe abnormality in social relationship.
- Help to reduce behaviour problems in the child. The child’s repetitive behaviour can be distressing for all concerned. Parent may need to provide a structured approach for his activities. Be aware of the situation that will provoke the child and avoid getting into them. Behaviour modification techniques include teaching the child a variety of coping skills such as ways to communicate when he cannot do so verbally. The child can be given feedback on his behaviour throught the use of rewards and punishments (such as time out). Seek the help of a child psychologist to develop an effective behaviour modification programme. As a trained professional, he can treat specific fears with behaviour methods called desensitization and flooding which help the child by exposing him to his fears either in a graded fashion or directly. Medication may be necessary in some situations.
- Parents’ distress need to be addressed. The parents and siblings may face many difficulties. Parents often deny the problem when they should be seeking professional help. If you suspect that your child has a pervasive development disorder, it is important to get appropriate diagnosis and early help.
Currently, the most effective treatment involves a combination of psychotherapy, special education, behaviour modification techniques, and support for families. Some children with Asperger’s Syndrome will also benefit from medication. The outcome for children with Asperger’s Syndrome is generally more promising than for those children successfully finish high school and attend college. Although problems with social interaction and awareness persist, they can develop lasting relationships with family and friends.
There are other less common variants of pervasive developmental disorders. If parents are worried, they should consult their family doctor or the child psychiatrist.
4) Distintegrative disorders
There are rare condition that occur in young children but two such conditions warrant some description: Disintegrative Psychosis and Landau Kleffner Syndrome.
- Disintegrative Psychosis. This rare condition was first described by Dr Theodore Heller in 1908. It is characterized by marked deterioration in various skills after apparently normal development for two to three years. The skills affected may be intellectual or skills of daily living like toilet training and dressing. Such children may lose the ability to speak and interact socially. They may also develop repetitive movements and become difficult to handle.
- Landau Kleffner Syndrome. This rare condition associated with epilepsy. The child loses his ability to speak although he may try to communicate in other ways. Although the exact causes have not been indentified, these disorders are thought to be developmental and are not curable per se. Treatment is symptomatic and works at trying to help the child as well as the family cope with the problems.
Preschooler problems:
1) Reactive attachment disorders
Associated with mother-child bonding problems described earlier, this disorder occurs in young infants and children. The most distinctive feature is the child’s abnormal behavior towards his caregiver, such he chooses to look away when he sees his mother. This disorder is the result of poor care given to the child’s emotional, physical and social needs. Often, he has had many different caregivers without an opportunity to form a stable attachment with them. Children with this problem are often from disruptive families.
2) Sleep disorders
Besides difficulty in falling asleep and waking up frequently in the night, preschool sleep disorders (or parasomnias) include:
- Nightmares and night terrors
- Sleep talking and walking
3) Delayed speech development
It is recognized that slow development in child’s language ability may point to learning disorders. At the same time, it is difficult to be definite as different children start to speak at different times. If parents and worried about their child’s speech development, they should seek professional help. Most speech delays are related to problems in expressing language. Parents should be aware that the child’s ability to comprehend is equally important. In fact, in normal development, a child would first understand instructions before he can speak.
We present a simple scheme for parents to analyse their child if they are worried about his speech development:
- Is there a hearing difficulty?
- Does the child understand what is being said to them?
- What is the child’s speech problem?
- Are there difficulties in other areas of his life?
- Does he find it difficult to socialize and relate to others?
What can parents do for a speech delayed child?
- Recognise that a problem exists.
- Seek help for the child’s problem as early as possible.
- Be actively involved in helping the child.
- Acknowledge that the medical diagnosis is merely a label. It is important to understand and cope with the problem.
- Realise that therapists advise and help parents and teachers who must work with the child.
- Remember that education cannot replace parents.
4) Stuttering
Stuttering or stammering, where sounds or words are repeated or produced with extreme tension, is a common problem especially among preschoolers. The peak age of onset is five years old but stuttering can occur anytime between two and seven years of age. About 3% of the children are afflicted and it is three times more common in boys than girls.
Stuterring is considered a disorder only if it is inappropriate for the child’s age. Most 2 and 3 year olds stutter but should grow out of it. If the problem persists, specialized help from the speech therapist should be sought. If the problem is severe, parent can choose to ignore or pay little attention to it. This is better than scolding or punishing the child. If the child becomes self conscious about it, he will continue to stutter. If an older child stutters and moves his body awkwardly, it may be necessary to refer him to a doctor.
What to do if my child stutters?
- Be patient and calm.
- Encourage the child to talk slowly.
- Don’t ridicule or imitate him.
- Talk slowly and clearly so that he has a chance
5) Selective mutism
Foundations for learning:
1) Physical health
2) Intellectual ability
3) The environment
4) Attitude
5) Mental health
Problems in young children:
1) Overachieving child
2) Underachieving child
3) Child with learning difficulties
4) Child with learning disorders
5) Mental health
6) Bed-wetting
7) Soiling
8) Attention Deficit Hyperactivity Disorder
9) Aggressiveness
10) Conduct related disorder
11) Emotional disorders
