Grandma spoils my kids!

From Dr. P's Message Board

Dr. P: "My mother totally spoils my little girl. What should I do about it?"

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This parent's dilemma is common and, in some ways, a nice one to have. Her daughter is blessed with doting grandparents, people whose sacred job in life is to spoil her rotten. Most of us adults wish we had someone like that in our lives, someone who, as the author Marcy DeMaree put it: "always made you feel that she had been waiting to see just you all day and now the day was complete."

Still, her question is a fair one: What to do about grandparents who treat their grandchildren differently than the parents? Put another way, do parents and grandparents need to be on the same wavelength with regard to the management and discipline of the children?

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For the majority of kids, I say "No!" Here's why.

Children (all people, really) are very adept at 'code switching.' That means we realize different settings and different people require different behaviors. We modify our behavior accordingly, showing restraint in one setting, letting loose in another. (Most of us, for example, act and feel quite differently around our parents than we do with our friends.) Our behavior is, to a large extent, appropriate and dependent on the context in which it occurs.

Your kids are plenty smart and learned this a long time ago. They know that grandma treats them a lot differently than you do, and that they can get away with certain behaviors with her that they never could at home. I suspect that when this little girl returns home, after a brief adjustment period she changes from 'spoiled-rotten, life-is-butter, I've-got-the-world-wrapped-around-my-adorable-little-finger' grandparent mode back into 'I'm-at-home, life-is-vegetables, and I-have-to-show-some-restraint" parent mode. Like the rest of us, she code switches.

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This description applies to most children - but not all - so I have two caveats:

1. There are some children - usually those with difficult behaviors and/or difficult temperaments - who do need consistency in the way they are treated by the important people in their lives. For such high-maintenance children, it is confusing and counterproductive for them to experience conflicting caretaking styles. In that case it's important to try to get everyone (school, grandparents, baby sitter, etc.) on the same page with regard to discipline.


2. You need to decide just how important these areas of conflict are to you. Whenever possible, I'd advise you not to sweat the small stuff. But only you can decide what the small stuff is. If, for example, you feel that eating junk food or not taking naps is truly injurious to your child, then by all means assert your parental privilege and insist that grandma comply with your wishes (of course, whether any grandparent ever listens to their grown child's opinions about how to rear their grandchildren is another question altogether!).
   

Or, better still, in the words of Gore Vidal: "Never have children, only grandchildren."

Related Topics:

• Diplomatic Guide for Grandparents
• Grand Parenting?

Is it wise to drug your kids to sleep?

Aaah, is there any sight more beautiful than a sleeping child? Their perfect features in innocent repose, their mouths open with the rhythmic flow of their sweet breath, their every pore radiating vulnerability and promise.

And, let's not forget, their blessed unconsciousness and immobility, so they can't bug us for a while with their incessant demands and needs. A mother once told me: "It's a good thing, Dr. P, that my baby didn't come equipped with an on/off switch or he'd be sleeping a whole lot more than he does now."

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That's one good reason to nix sleeping medications for kids: the irresistible temptation to drug kids into unconsciousness to suit parental convenience. After all, we have competing agendas: kids want to stay awake, adults want them to fall asleep. Using drugs makes it an unfair fight, just too easy to activate the off switch. Furthermore, where do you draw the line? What about the 4-month old who doesn't sleep well? Or a 2- year old?

Even more worrisome: we don't know the long-term side effects of sleep medications on kids. This is especially problematic as most physical growth and the consolidation of long-term memories occur during sleep.

On the other hand, there are many new studies demonstrating how insufficient sleep is wreaking havoc on children's behavior and development. Children, we are told, need their 8-10 hours or else. The problem is no one knows how to coax kids into sleeping more. So let me ask the unaskable: if they were known to be safe, why not use drugs to that end?

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Before you answer, let's complicate the issue.

There are some developmental disorders (like ADHD and autism) in which the lack of sleep clearly has a negative impact on children's behavior and development. It's a clinical issue I frequently face, so I was relieved to see a new study* that examined the effectiveness of melatonin - a natural hormone made by our glands when we sleep - on 107 poorly sleeping, autistic kids.

With a dose of about 1-6 mg, 25% of their parents said the sleep problem had been solved and 60% said it had improved. Better still, only three families reported mild side effects (morning sleepiness, bedwetting).

Maybe you'll agree with me that medications can be a good idea for autistic or ADHD children with sleep problems. Certainly I prescribe them for that reason all the time, often with gratifying results for parent and child. But what about using drugs in 'typical' kids who don't sleep well. Shouldn't they and their parents be allowed the benefits of a full night's rest, especially when there appears to be a 'natural' drug that is both safe and effective?

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Consider this scenario. Let's assume you have a healthy nine year old child, Beckett, who goes to bed at 8, but doesn't fall asleep until midnight. In the morning it's impossible to awaken Beckett and he is wicked cranky to get off to school. Let's assume that you've instituted good 'sleep hygiene' measures (no TV in the room, a consistent bedtime, a consistent bedtime ritual of reading a story, winding down with a bath before falling asleep, etc.). And let's assume Beckett doesn't snore or have signs of disturbed sleep or obstructive sleep apnea.

This was exactly the challenge I recently faced in my practice. Beckett's desperate, bleary-eyed parents wanted me to OK a medication to improve the duration and quality of his sleep. I told them no because of the concerns I already discussed. Am I being appropriately cautious or just a Luddite (i.e., reflexively anti-progress) wimp?

As I later learned, Beckett's parents judged me to be the latter. When I saw them recently (for another reason), his mom looked at me somewhat accusingly and told me that, despite my cautions, they were giving Beckett melatonin and...success! He was falling asleep much earlier and he seemed to be more rested and even-tempered during the day, as were his parents, so whatdoyouthinkofthat Dr. P???

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I know, I know: many of you and many of your kids are just soooo tired. Everyone in the family needs relief. Will you - should you - then choose to give your sleepless in Cheboygan child this 'natural' substance (or the next one that rolls around) that promises to fix the problem without apparent side effects, perchance to dream?

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Article cited:
* Melatonin for Insomnia in Children With Autism Spectrum Disorders
Andersen, I, Kaczmarska, J, McGrew, S, Malow, B.
Journal of Child Neurology, January 2008
http://jcn.sagepub.com/cgi/rapidpdf/0883073807309783v1

Related Topics:

• WebMD Video: Identifying Sleep Disorders in Children
• 7 Ways to Combat Kids' Sleep Problems

Technorati Tags: pediatrics, sleep, insomnia, children, medication, sleep disorders, melatonin

Non-Beneficial Research: Would You Sign Up Your Kids?

Here's the dilemma. Very little research is done on children to examine their responses to adult-tested medications. So when we pediatricians then need to prescribe a medication, the effectiveness is often unclear, the risks are often unknown, and the dose is often an educated guess.

I know - not exactly what you as a parent want to hear about the 'science' of prescribing 'off-label' (meaning untested, which most are) medications for your kids. I agree. I'm not comfortable or happy about this state of affairs. Still, like all pediatricians, despite the lack of scientific evidence, I soldier on and continue to prescribe those medications to my little patients. Should I do otherwise?

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This question arises when we read disturbing stories about medications that, unexpectedly, are not helpful or are even harmful in kids (e.g., cough and cold medicines - see my recent post on this: ROUND 2: The FDA and OTC Cold Medications for Infants). When that happens, everyone clucks: How could pediatricians have used these medications when there was no evidence of benefits for kids and when the risks were unknown? It's shameful!

Certainly, we all would like to see more research done on children. Or would we, really?

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Let me make this issue personal: Would you allow your child to be enrolled in a research study that would be of no benefit to him/her and might have some risks, even if the information derived from the study might some day benefit other peoples' kids?

An interesting new study* asked 81 parents just that question, followed by differential risks: "a chance of getting a headache for a few hours" or "a small chance of a broken bone" or "a one in a million chance of dying" or "the same risk as riding in a car". How would you respond?

Results:

• 79% of parents said they would let their child participate if there were only the risk of getting a headache.


• 24% would allow it if there was a small risk of a broken bone.


• 18% of parents would OK the research if there were a one in a million chance of death.


• 93% of parents said OK if the risks were the same as riding in a car. (By the way, the risk of being killed while riding in a car is about one in a million!).

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Dr. P Comments
So there you have it. We indignantly condemn the lack of studies on medications for kids but - quite understandably and justifiably - most of us wouldn't allow our kids to be involved in such research.

So the next time a bad side effect of a medication generates lots of heat and everyone tut tuts the fact that it was used in children without scientific evidence, ask yourself: what was the alternative? Should we never use any medications in children for which there is little or no scientific validation? If that were to happen we'd almost never use medications in kids at all. Welcome back to the 19th century.

If you are unwilling to enroll your children in research, then maybe you too will have to embrace our imperfect solution: to keep giving these adult-tested meds to kids, to hope they help and not hurt, and to be ever vigilant for evidence of no benefit and possible harm.

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*Study cited:
"Children's and their parents views on facing research risks for the benefits of others."
Wendler D and Jenkins T. Archives of Pediatric and Adolescent Medicine. January 2008

Related Topics:

• WebMD Video: Treating Baby's Cold
• Concerns for Women, Children in Clinical Trials

Technorati Tags: pediatrics, medicine, colds, clincial trials