Tagged Children and Childhood

The Intentional Summer


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Summer officially starts today, brimming with delicious potential. You may think you don’t need to schedule summer fun — it just happens, right? Well yes, sometimes, but research shows it helps to plan for it.

Well Family is declaring this the Intentional Summer, and we’re here to help you avoid regrets over missed opportunities. Every week, we’ll offer research-based suggestions for ways to set this season apart from the rest of the year.

The sense that summer fun slips through our fingers is real, and it’s reflected in how people report feelings of health and well-being over the course of a 24-day vacation: Our positive feelings increase quickly at the outset, peak about one-third of the way through and then start a downward slide toward our baseline happiness — and sadly, leave us back there about a week after we return to work.

Jessica de Bloom, the researcher on that and other studies on vacation and happiness, suggested that we take time to consider how we can maximize our summer pleasure, even when we’re not on vacation. A sense of autonomy — of making active decisions about how we spend our time — is one of the elements that helps us enjoy our free time.

“Make ordinary evenings and weekends more memorable,” she said. Do the things you normally do “a little bit differently. Take a bike instead of the bus” or car. Research also suggests that people appreciate their leisure most when it includes elements of challenge, connects us with the people we care about, or helps us to feel a sense of purpose, she said.

To add some or all of those elements to these few weeks of summer, planning is essential. As a bonus, planning and anticipating something new can boost our happiness. Once we’re carrying out our plans, said Dr. de Bloom, we need to detach from our usual roles (and our gadgets), relax and savor the experience.

Join us! Every week for the next two months, we’ll propose a simple challenge to help connect you to the season and to the people you love. We’ll be listening to your feedback. Expect fresh ways to get outdoors, get moving (and slow down) and flavor your summer.

Having started with the solstice, we’ll end with another astronomically notable event: the annual Perseid meteor showers, which occur every August and peak this year around the 12th of the month (start thinking now about where you can find some dark sky to watch those “shooting stars”).

This week’s challenge: Walk or bike to somewhere you would normally drive or reach via public transportation. Pick a short distance that might turn into a summer ritual (a bike ride to the library, for example) or a longer trek.

A friend and I once took an entire summer day to walk from his apartment on the Upper East Side of Manhattan down to Battery Park City, something I still remember over a decade later. And that’s exactly the point, said Gretchen Rubin, the author of “Better Than Before” and host of the “Happier” podcast. “Life feels richer when some parts of it are different.” Routine days run together into a single memory, while special things stand out.

If you’re walking with children, let them help pick a destination, mode of transport and route. Leave enough time to enjoy unexpected discoveries along the way, whether it’s a street fair or a turtle living in the run-off ditch by the side of the road.

Let us know how you do by commenting here or emailing us at wellfamily@nytimes.com before next Tuesday, June 28. Was it more fun than you expected, or did things go wrong? Would you do it again? Did you make a day your family will remember? You can also share on Twitter, Instagram or Facebook (#intentionalsummer).

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We’ll share reader stories and post next week’s challenge on Thursday, June 30. The real goal: to savor the summer all season long.

Why Handwriting Is Still Essential in the Keyboard Age


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Do children in a keyboard world need to learn old-fashioned handwriting?

There is a tendency to dismiss handwriting as a nonessential skill, even though researchers have warned that learning to write may be the key to, well, learning to write.

And beyond the emotional connection adults may feel to the way we learned to write, there is a growing body of research on what the normally developing brain learns by forming letters on the page, in printed or manuscript format as well as in cursive. In an article this year in The Journal of Learning Disabilities, researchers looked at how oral and written language related to attention and what are called “executive function” skills (like planning) in children in grades four through nine, both with and without learning disabilities. Virginia Berninger, a professor of educational psychology at the University of Washington and the lead author on the study, told me that evidence from this and other studies suggests that “handwriting — forming letters — engages the mind, and that can help children pay attention to written language.”

Last year in an article in The Journal of Early Childhood Literacy, Laura Dinehart, an associate professor of early childhood education at Florida International University, discussed several possible associations between good handwriting and academic achievement: Children with good handwriting may get better grades because their work is more pleasant for teachers to read; children who struggle with writing may find that too much of their attention is consumed by producing the letters, and the content suffers.

But can we actually stimulate children’s brains by helping them form letters with their hands? In a population of low-income children, Dr. Dinehart said, the ones who had good early fine-motor writing skills in prekindergarten did better later on in school. She called for more research on handwriting in the preschool years, and on ways to help young children develop the skills they need for “a complex task” that requires the coordination of cognitive, motor and neuromuscular processes.

“This myth that handwriting is just a motor skill is just plain wrong,” Dr. Berninger said. “We use motor parts of our brain, motor planning, motor control, but what’s very critical is a region of our brain where the visual and language come together, the fusiform gyrus, where visual stimuli actually become letters and written words.” You have to see letters in “the mind’s eye” in order to produce them on the page, she said. Brain imaging shows that the activation of this region is different in children who are having trouble with handwriting.

Functional brain scans of adults show a characteristic brain network that is activated when they read, and it includes areas that relate to motor processes. This suggested to scientists that the cognitive process of reading may be connected to the motor process of forming letters.

Karin James, a professor of psychological and brain sciences at Indiana University, did brain scans on children who did not yet know how to print. “Their brains don’t distinguish letters; they respond to letters the same as to a triangle,” she said.

After the children were taught to print, patterns of brain activation in response to letters showed increased activation of that reading network, including the fusiform gyrus, along with the inferior frontal gyrus and posterior parietal regions of the brain, which adults use for processing written language — even though the children were still at a very early level as writers.

“The letters they produce themselves are very messy and variable, and that’s actually good for how children learn things,” Dr. James said. “That seems to be one big benefit of handwriting.”

Handwriting experts have struggled with the question of whether cursive writing confers special skills and benefits, beyond the benefits that print writing might provide. Dr. Berninger cited a 2015 study that suggested that starting around fourth grade, cursive skills conferred advantages in both spelling and composing, perhaps because the connecting strokes helped children connect letters into words.

For typically developing young children, typing the letters doesn’t seem to generate the same brain activation. As we grow up, of course, most of us transition to keyboard writing, though like many who teach college students, I have struggled with the question of laptops in class, more because I worry about students’ attention wandering than to promote handwriting. Still, studies on note taking have suggested that “college students who are writing on a keyboard are less likely to remember and do well on the content than if writing it by hand,” Dr. Dinehart said.

Dr. Berninger said the research suggests that children need introductory training in printing, then two years of learning and practicing cursive, starting in grade three, and then some systematic attention to touch-typing.

Using a keyboard, and especially learning the positions of the letters without looking at the keys, she said, might well take advantage of the fibers that cross-communicate in the brain, since unlike with handwriting, children will use both hands to type. “What we’re advocating is teaching children to be hybrid writers,” said Dr. Berninger, “manuscript first for reading — it transfers to better word recognition — then cursive for spelling and for composing. Then, starting in late elementary school, touch-typing.”

As a pediatrician, I think this may be another case where we should be careful that the lure of the digital world doesn’t take away significant experiences that can have real impacts on children’s rapidly developing brains. Mastering handwriting, messy letters and all, is a way of making written language your own, in some profound ways.

“My overarching research focuses on how learning and interacting with the world with our hands has a really significant effect on our cognition,” Dr. James said, “on how writing by hand changes brain function and can change brain development.”


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The New Dads’ Club


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When my wife, Courtney, and I were expecting our first child just a few years ago, I was astonished by the almost instantaneous community of expectant and new mothers that greeted her. Despite the fact that we’d just moved cross-country and didn’t yet know many people, she was flooded with sage advice and a deep sense of community.

It was impressive, and yet it often left me feeling like a bystander. As I watched the anticipation of these expectant mothers shift into weekly get-togethers with babies rolling around on blankets on the floor, I found myself envious and wondering: Where was the parallel universe of new dads?

Online, I found several hip publications on fatherhood — from the popular website Fatherly to Charlie Capen and Andy Herald’s widely read “How to Be a Dad,” and “Designer Daddy,” focused on “getting creative with fatherhood.” When our schedules aligned, my friend Peter and I would get vulnerable as we ran through the redwoods. We’ve had several unforgettable conversations about impossibly hard stuff like the loss of his first son and others on the pressure to strike that perfect balance with our wives — who both always seem to be one step ahead of us in this whole parenting thing. Yet nothing seemed to approximate the collective conversations that were happening among my wife and her new mom friends.

Economic and cultural shifts in the last decade have made fatherhood feel like uncharted territory in many ways. In the wake of the recession and the fracturing of the economy, many men, myself included, are less tied to a traditional workday as sole breadwinners. More than a third of American workers are now freelancers, according to an independent study commissioned by the Freelancers Union in 2014.

Many men are increasingly moving beyond the “bringing home the bacon” mentality, and instead prioritizing the careers of wives who make more money than they do. According to the Bureau of Labor Statistics, 28.2 percent of wives earned more than their husbands in 2014 (in families in which both wives and husbands have earnings). Back in 1987, when I was a kid, only 17.8 percent of American wives brought home more money than their husbands.

These trends are creating entirely new opportunities and challenges for fathers: finding ourselves engaged with aspects of caretaking that many of our own fathers never experienced, more distracted at work, or even less career-oriented in some cases, again, like mine. Men and women, in a sense, are at least getting closer to being equal partners in this journey; according to the latest Pew surveys on modern parenthood, 56 percent of mothers and now 50 percent of fathers say juggling work and family life is difficult for them.

After experiencing, often appreciating, and sometimes lamenting many of these dynamics for the first two years of our daughter’s life, I decided to try to bring some dads together to talk about our shared experience. I had a hunch that I wasn’t the only one yearning for a community and some deeper conversation on fatherhood.

I identified 28 relatively new fathers, mostly through my wife’s friends, and finally worked up the courage to invite them. A stream of responses to my email invitation came promptly and enthusiastically.

On a cool, Bay Area night, those two dozen eager dads (few of whom knew one another) showed up at our place with an enviable array of fancy cheeses, a homemade coffee cake, some Brussels sprouts smoked via some jury-rigged stovetop contraption, and no small amount of uncertainty about what the hell they were doing there. If all else failed, at least we wouldn’t starve.

Among us were both nonprofit and tech company workers, stay-at-home dads, a tattooed investment banker-turned-restaurateur, and a couple of writers, myself included. Most had one child; a few had two.

Nervously excited and visibly breaking a sweat, I explained my reason for bringing the group together: to give new fathers a chance to talk honestly about the highs and lows of their new identity, together.

Throughout our conversation, the mood in the room was fun and lively, but at other times it also felt almost sacred. Although there were many moments of group laughter, unlike so many typical gatherings of guys where there is often cross-talk and side jokes, only one person spoke at a time.

To get things started, I asked the group: “What has surprised you most about fatherhood?” (My wife, a skilled facilitator, had suggested it.) The answers were remarkably wide-ranging. “My own parents seem to care very little about my children,” one dad said. “Having a child has made me lose my career ambition,” said another.

For many of us, as much fun as it can be, being a father is all-consuming and omnipresent, blurring time and space like few other experiences. Some days, especially during those early sleepless nights, it’s hard to know which end is up. And yet these few hours of conversation every couple of months somehow manage to stay with me. I often find myself reflecting on things other fathers said in our groups, days, weeks or even months after the fact. Others have reported the same.

At the end of that first night, one of the other dads asked: “How often do you guys have conversations like this, with other guys? Once a week? Once a month? Once a year?” After the last prompt, finally a mass of hands started going up.

Guys like us, it turns out, are hungry for a place to talk with other men, particularly about how fatherhood is changing us, and changing writ large. Just as literature has long helped people see that our seemingly personal struggles are universal, being able to talk in this group offers a similar revelation. In an age of near-constant superficial virtual connection, there’s an enormous benefit in having a real life community to confide in more deeply and provide a genuine social network — especially for men and young fathers so often without it.

John Cary is the editor of “The Power of Pro Bono” and a strategist for TED.

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For U.S. Parents, a Troubling Happiness Gap


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For years, social scientists have known that nonparents are happier than parents. Study after study has confirmed the troubling finding that having kids makes you less happy than your child-free peers.

Now new research helps explain the parental happiness gap, suggesting it’s less about the children and more about family support in the country where you live.

Based on data from 22 countries and two international surveys of well-being, researchers found that American parents face the largest happiness shortfall compared to people who don’t have children. The happiness gap between parents and nonparents in the United States is significantly larger than the gap found in other industrialized nations, including Great Britain and Australia. And in other Western countries, the happiness gap is nonexistent or even reversed. Parents in Norway, Sweden and Finland — and Russia and Hungary — report even greater levels of happiness than their childless peers.

The researchers, led by the University of Texas sociology professor Jennifer Glass, looked for factors that might explain the international differences in parental happiness, and specifically why parents in the United States suffer a greater happiness penalty than their peers around the world.

They discovered the gap could be explained by differences in family-friendly social policies such as subsidized child care and paid vacation and sick leave. In countries that gave parents what researchers called “the tools to combine work and family,” the negative impact of parenting on happiness disappeared.

“We comprehensively tested every other alternative,” said Dr. Glass, the lead author of the study, which will be published in the American Journal of Sociology in September. “The two things that came out most strongly in explaining the variation were the cost of care for the average 2-year-old as a percent of wages and the total extent of paid sick and vacation days.”

Notably, the researchers found that economic differences, whether a parent was married or partnered and whether the pregnancy was planned or unintended had no impact on the happiness gap. They also considered the impact of other family-friendly social policies, such as extended maternity and paternity leaves, flexible schedules and even policies that gave money to parents in the form of a child allowance or monthly payments.

Paid parenting leave has “nowhere near as big an effect as these other two policies, “said Dr. Glass, while the other policies didn’t have a significant impact on the happiness gap. Policies that made it less stressful and less costly to combine child rearing with paid work “seem to be the ones that really matter.”

Those same two policies, she said, were also correlated with increased happiness among nonparents. That more paid sick leave and vacation time would make nonparents happier was no surprise, but “we were a little puzzled that lower child care costs would show an effect on nonparents,” Dr. Glass said. She and her colleagues speculate that the result is what economists call an indirect benefit: Everyone is better off when countries invest in the future of their labor force, and everyone suffers when they don’t.

But while there are certainly distinctions in family policy to be made between the United States and other developed countries, there are also substantial cultural differences in the ways children are raised here and in other countries. Those distinctions are hard to measure, but might also account for some of the relative difference between parental and nonparental happiness.

“There’s an incredible anxiety around parenting here that I just don’t feel in other countries,” said Christine Gross-Loh, the author of “Parenting Without Borders,” a comprehensive look at modern parent culture across the developed world, who is raising her children between the United States and Japan. She points to Americans’ anxiety around children’s college and future prospects, and also to our emphasis on keeping children physically safe, and the harsh judgment of parents who are perceived to be doing a poor job of it.

“In Japan, my 6-year-old and my 9-year-old can go out and take the 4-year-old neighbor, and that’s just normal,” she said, while in the United States that kind of freedom can draw criticism and even lead to interventions by Child Protective Services.

In countries where there is a strong agreement about the norms around parenting, parents may worry less about their own choices. Without a single overarching parenting tradition, American parents may feel like they have “too many choices” as compared to parents in more homogeneous cultures, says W. Bradford Wilcox, an associate professor of sociology and the director of the National Marriage Project at the University of Virginia. “A clear and well-defined script can be psychologically comforting,” he said, and its lack can leave parents feeling “unmoored.”

Dr. Glass agrees that cultural differences add to the greater relative parent and nonparent happiness gap — but she notes that those cultural differences are also reflected in our family policies. Much of our anxiety around our children in the United States, she said, is very clearly a reflection of our policy choices.

“We have to compete for good child care. We compete to live where there’s a good elementary school,” she said. “We compete for activities because a child’s entire fate seems to depend on where he goes to college, because there’s no guarantee — if we don’t, our child might be left behind.”

Those fears, Dr. Glass said, come in part from our country’s high tolerance for unequal access to the resources families need. In countries that offer policies supporting a parent’s ability to balance work and family, she sees a commitment to egalitarianism. “A crucial part of what’s going on is the idea that every child deserves an equal chance in life,” she said.

The good news is that the findings show that the happiness gap of parenting is not inevitable. Stephanie Coontz, who teaches history and family studies at The Evergreen State College in Olympia, Wash., and is co-chairwoman of the Council on Contemporary Families, said it was a pleasant surprise to see the researchers document the need for better family policies.

“Don’t just swoop in and give a longer maternity leave,” Dr. Coontz said. “It’s a lifetime investment in helping people combine work and family for the long haul.”

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The Teenager With One Foot Out the Door


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High school graduation can give way to an uneasy season in the raising of a teenager. In place of a summer of family togetherness, parents often feel out of step with adolescents who are preparing to leave home. Though there are certainly joys that come with having a young adult around the house, they can’t cancel out the parting tensions that many families face.

Parents sometimes warn one another about teenagers who feel compelled to soil the nest before flying off to college or other adventures. Home life can become so unpleasant that those who once dreaded their graduate’s departure can’t wait to pack his or her bags. There’s a hidden function to this friction: It’s easier to part from people whose company we can hardly stand.

But subtler dynamics can also be at work. Firm plans for moving out may heighten a teenager’s tendency, which the psychoanalyst Anna Freud observed in 1958, to live “in the home in the attitude of a boarder.” With one foot out the door, a teenager may treat his parents like meddlesome landlords if they should ask what time he will be coming home, or suggest that he drive younger siblings to soccer. And just when new grads are resisting rules and expectations that held sway only a few weeks ago, their folks are often itching to offer some last-minute guidance.

Parents who want to discuss sexual ethics, finances, the hazards of heavy drinking or even the importance of getting enough sleep rarely find an eager audience in teenagers who have already decamped psychologically. These moments may be easier to navigate if we consider why adolescents act like tenants in the first place. It’s a huge developmental step to leave home, a step that teenagers don’t take all at once. Tweens usually begin the slow process of departing by closing their bedroom doors to do the exact same things they used to do with their doors wide open. In their last weeks around the house, adolescents travel the final stretch of this path. They practice living on their own while still enjoying, if they’re lucky, the safety and support of a loving home.

We shouldn’t give up on talking with teenagers about how they will care for themselves and treat others once they move out. But we should set aside the expectation of lengthy heart-to-heart talks. When teenagers are broadcasting their detachment, the most successful conversations may be the ones that begin, “It might seem like we’ve already covered this, but there are just a few things I want to touch base about before you go. I promise to keep it short.”

When soon-to-depart teenagers aren’t rubbing family members the wrong way or holed up in their rooms, they’re often nowhere to be found. Feeling confident in their ties to their parents, adolescents cling to their friends. Or they immerse themselves in efforts to resolve a meaningful high school romance. My years of working with teenagers have taught me that a surprising number of recent grads find themselves in pop-up entanglements that bloom, out of nowhere, in late summer.

Parents who are trying to cherish a teenager’s last days under their roof may be reluctant to split time with high school friends or a serious romantic partner, much less with a passing fling. But adults don’t need to take a teenager’s consuming social life as a personal rejection. The intense focus on peer relationships is often connected to the psychological strain of parting with family. A teenager who preoccupies himself with saying goodbye to his friends often manages to distract himself from difficult feelings about leaving his family. Agonizing about the future of an obviously doomed 11th-hour relationship beats tuning in to the full sadness of moving away from a beloved sibling.

It’s no picnic to send a teenager into the world. Most parents feel both wistful about the past and anxious (and perhaps even a bit envious) about their adolescent’s future. Must we add feeling at odds with or ignored by our teenagers to this emotional stew? Perhaps we could simply discuss these common post-grad dynamics with our adolescents, then go on to enjoy our last summer together.

We could. But we probably shouldn’t.

With their parting maneuvers, young people are subconsciously tempering the emotionally intense, landmark moment of leaving home. In moving out, teenagers give up almost everything they have ever known, with little grasp of what they are getting. It’s no surprise that they rely on adaptive, if sometimes off-putting, psychological defenses to buffer such a stressful transition.

As for the adults, there may be some comfort in knowing that high school graduation isn’t the end of parenting. It simply marks the next phase of it: the one where we bear with our teenagers as they find their way to the door.

Lisa Damour is a psychologist in private practice in Shaker Heights, Ohio, a clinical instructor at Case Western Reserve University and the director of Laurel School’s Center for Research on Girls. She is the author of “Untangled: Guiding Teenage Girls Through the Seven Transitions Into Adulthood.” Follow her on Twitter: @LDamour.


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Sibling Rivalry: The Grown-Up Version


The cast of “The Humans,” from left, Reed Birney, Cassie Beck, Jayne Houdyshell, Sarah Steele, Lauren Klein, and Arian Moayed.

The cast of “The Humans,” from left, Reed Birney, Cassie Beck, Jayne Houdyshell, Sarah Steele, Lauren Klein, and Arian Moayed.Credit Sara Krulwich/The New York Times

At a recent dinner party, one guest said, “My brothers have not been in the same room for 16 years.” Another is estranged from a sister who she feels over-guards their widowed mother. Yet another lives in the same building as a brother with whom she no longer talks.

Welcome to sibling rivalry, the grown-up variety. There is no law that says we have to love the ones we were raised with, or even that we must reconcile before the grand finale. But as millions of baby boomers hit Act Three, the issue is rankling a generation that grew up believing in sharing, openness and the concept of “closure.”

“I’ve always thought that the psychological field does not give enough attention to the huge impact of siblings,” said Dr. Anna Fels, a psychiatrist in private practice in New York. She is not alone in that sentiment. Dr. Roger Gould, also a New York psychiatrist, agrees: “As I think about my current caseload, every one has a strained, difficult relationship with at least one of their siblings.”

If you have any doubts, look at the culture. On stage in New York recently, “The Humans,” “Dot,” “Familiar,” “Hold On to Me Darling,” “Buried Child” and “Head of Passes” all touch on siblings dealing with money, memories and taking care of ailing parents. The television show “Transparent” may purport to be about a 70-year-old man-turned woman, but it is really about the family’s next generation, acting more like children than children. The Netflix series “Bloodline” has just returned for a second season and deals with four siblings, one of whom — spoiler alert — drowned another at last season’s end. In the film “Alice Through the Looking Glass,” sibling rivalry nearly stops time.

Three books on the best-seller list deal with feuding siblings, including “The Nest” (“Jack and Leo were brothers but they weren’t friends”; “Miller’s Valley,” in which two sisters live on the same property but don’t speak to each other; and “The Nightingale,” about two very different sisters during World War II.

“Readers want to recognize themselves in fiction,” says Anna Quindlen, author of “Miller’s Valley,” “and I think most have some aspect of sibling conflict. In terms of those power relationships, there is no such thing as being grown up. At some level I will be an oldest child until the day I die.”

Most assume the fractures have to do with money, as parents die. What to give away, what to save or how to split? But is it really that simple?

“Usually these start out being about dividing up money, but underneath, it’s about things the siblings have avoided for decades,” says Frederick Hertz, a financial mediator based in Oakland, Calif., who is writing a book with the working title,  “Can I Divorce My Sister?” “Their childhood is such an integral part of their identity, and it sometimes becomes hard to put that aside enough to engage in practical decisions. I recently met with a brother and sister during which she stormed out saying, ‘He’s lived off our parents for 50 years!’ All that kind of stuff comes up.” That “stuff” may include one sibling feeling another was favored, thinking he or she was not defended against some form of abuse, or simply being a living reminder of disappointment and distress.

When in doubt, we can always blame Mom and Dad. A 70-year-old man told me he was close to his younger brother in childhood. “I sort of took on the father role. There was minimal parental praise, and let’s say I got less bad attention.” But the boy for whom he wrote class papers and took to the orthodontist, turned into the man who one day said, “I used to think you were the best and now you are the worst brother.” They have not spoken in 10 years.

Envy also can rear its ugly head after all these years. “In my sister’s mind, my arrival signaled the end of her seven-year reign on a pedestal,” a 55-year-old woman told me. A few years ago, she flew from New York to Seattle for her sister’s lung cancer operation. “She came out of recovery, saw me, and said, without the slightest sense of gratitude, ‘What are you doing here?’.” The act was not reciprocated when the younger sister developed breast cancer.  She recalled, “My sister said, ‘Of course you would get the cancer that is more treatable.’”

Occasionally a bar mitzvah or wedding may bring squabbling siblings together, but then the parties tend to go back to their corners. More likely, reconciliation comes when an end is in sight. Says Dr. Gould: “Whenever a crisis or death occurs — even though old wounds are opened — the rawness of the experience makes old slights irrelevant and the old image of ‘the other’ vanishes.”

Such occasions can prompt an effort toward reconciliation. Or not. Dr. Vivian Diller, a psychologist, said: “Being aware that we are living longer gives some a sense of new beginnings, with new choices. The byproduct can result in leaving behind poor sibling relationships or working on ones that are worth the effort.”

Experts suggest that parents encourage more family togetherness and extend equal love early on. As they grow, siblings should acknowledge one another’s flaws, which can help to lower expectations. Seeking help from therapists or mediators can bring the real issues out into the open.

“I do see more of a willingness to get therapy,” Dr. Fels said. “Professionals can also help people to recognize — and perhaps even accept — that a sibling might have legitimate mental health issues,” she said. All of the above may improve matters in some families. But there is no guarantee.

Michele Willens is a freelance writer and podcaster for NPR’s Robinhoodradio.

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Should Pediatricians Refuse to Treat Patients Who Don’t Vaccinate?


Alice Hansen, 2, receives a pertussis vaccine while her mother, Alishia Hansen, holds her.

Alice Hansen, 2, receives a pertussis vaccine while her mother, Alishia Hansen, holds her.Credit Matthew Ryan Williams for The New York Times

Parents who don’t want to vaccinate their children are a perennial sore subject in my profession. The question bubbled up again this spring at the American Academy of Pediatrics’ Annual Leadership Forum, where academy leaders vote on issues of concern to pediatricians across the country.

Two of the top three resolutions this year were about vaccine refusal. One requested a policy statement calling for the elimination of nonmedical exemptions to the requirement that children be immunized to attend school and day care. The other asked the academy to support “pediatricians who decide to discharge patients after a reasonable, finite amount of time working with parents who refuse to immunize their children according to the recommended schedule, or who fail to abide by an agreed-upon, recommended catch-up schedule.”

Let me tell you about two cases of pertussis — whooping cough — from about 15 years ago. The first one is my own, probably caught from a sick kid, back before the development of the adult booster shot; thanks to an astute colleague, I got the diagnosis, and we began the wearisome task of contacting the families of every child I had seen in the clinic or the newborn nursery during my infectious days to inform them of the possible exposure.

I didn’t give it to him, but the second case was a preschool-age patient of mine whose mother had refused vaccination, insisting that she wanted to wait on the vaccine that protects against pertussis. It wasn’t a terribly dangerous case of whooping cough; the patient’s airway wasn’t compromised, the way infants’ airways often are, but he was pretty sick and pretty miserable for a good long time. As was I; we treat pertussis with antibiotics, which make the sick person noninfectious, but the cough, which is severe enough to cause rib fractures in some unfortunate patients, can persist for six weeks or more.

I felt guilty that I had failed to diagnose the illness in myself promptly enough. I felt a different guilt about my patient, wretchedly certain that if I had only been more eloquent and more persuasive, his mother would have come around to the idea of vaccination and he would have been spared the coughing paroxysms that convulsed his little body, often followed by vomiting.

I tell you this to help explain the way that pediatricians feel about immunizations.

The resolution about “discharging” nonvaccinating families was introduced by Dr. Kimberly Avila Edwards, a pediatrician in general practice in Kyle, Tex., with a large multispecialty group that serves the Austin area. Some of their offices were seeing increasing numbers of parents who refused vaccination, and the physicians were struggling with how to care for those families. And she said parents who do vaccinate and were worried about possible exposures to diseases in the waiting room “were asking, ‘Do you accept nonvaccinators, because if so, we don’t want to come here.’” The biggest waiting room fear is that babies too young to be fully immunized might be exposed to preventable illnesses like whooping cough, measles, and influenza.

The doctors discussed the question, she said, reading the current A.A.P. policy, which seemed to them to discourage doctors from discharging these patients, and then decided to make a new practice rule. “We are going to give families a finite amount of time for a parent to say, O.K., I am going to start vaccinating my child and adhere to the catch-up schedule,” she said. “If parents still choose not to vaccinate, we are unfortunately not going to be able to continue to see you.”

This is a strategy for private practices, where families have some choice about which doctors to patronize; “safety net” clinics, like the one where I practice, which serve poor children, cannot “exclude” families in this way. And studies have shown that in this country, those who don’t vaccinate tend to be affluent, white and suburban.

Even if they have the choice, should we be steering nonvaccinating families toward health care settings that may not push as hard to change their minds? Dr. Carol Baker, an expert in pediatric infectious diseases and a professor of pediatrics at Baylor College of Medicine, thinks the academy should not change its existing position. Doctors are reacting negatively to the time and effort that these families consume, she told me, and the fear of being sued if a dangerous disease is passed along in their waiting room.

Even so, she said, doctors have to keep talking to the parents, and trying to get the children vaccinated. “For the academy to give permission that you don’t have to try is an ethically poor position,” she said.

Although the resolution met with general approval at the meeting, there was opposition from some bioethicists present. Dr. John Lantos, a pediatrician who is the director of the Children’s Mercy Bioethics Center in Kansas City, argued that the current A.A.P. statement strikes the correct balance in encouraging pediatricians to keep talking to “vaccine hesitant” parents: “Try hard to work with people.”

Dr. Avila Edwards said that the new rule at her practice that gives families a finite time period to consider vaccination led to “respectful one-on-one discussions,” which often ended up with families making the decision to vaccinate and stay.

Dr. Lantos argued that doctors are saying that this is a question of beliefs so fundamentally divergent that it’s impossible to work together, as if “vaccines are an order of magnitude higher than anything else.” Parents may choose to disregard other pediatric guidelines — smoking in the home, not applying sufficient sunblock — without being asked to leave a practice. The medical obligation is to educate parents, to try to get them to do the right thing for their children, not to give up on them.

If the worry is other children’s being exposed in the waiting room, he said, doctors could focus on measures to keep sick kids separate, or out of the waiting room until a doctor is available. “And if your concern is that these infected kids are going to go out and infect other kids — if you fire them from your practice, there would be more unimmunized kids in the world,” he said, since the hope is that if the families stay in the practice, eventually they may be persuaded. “Most people don’t say, nobody should see these kids; they just say, my practice shouldn’t see these kids. But if everybody said it, the world would be a much worse place.”

Most pediatricians have seen at least some of the diseases that vaccines protect against, from whooping cough to meningitis to the really bad cases of influenza and rotavirus. The children who aren’t protected worry us, because they make us feel we aren’t doing our job of keeping them safe in a world that is a much better and safer place to grow up — because of vaccines.


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How to Tiptoe Around a Depressed Mother


Credit Giselle Potter

A depressed mother hates noise. She hates a lot of things — sometimes it seems as if she hates everything. But noise is her particular enemy. This is because she needs her sleep. She doesn’t always seem tired. But sleep is sacred to her, and you must never interfere with it. Particularly in the mornings. This makes life complicated if your bedroom — the nursery — is directly above hers and the floors are covered in linoleum, as they are in London in the 1960s. When you wake up and need to go to the bathroom you must avoid certain creaky spots. So you navigate like a cat burglar, tiptoeing on the more solid sections until you get to the stairs down to the bathroom. You hold your breath as you pee as if not breathing will somehow mitigate the sound. Do you flush? Not at this ungodly hour.

Silence is what your mother craves, but it is also her weapon. When she is in one of her moods, she settles into a powerful silence. She actively ignores you. She doesn’t respond to your attempts at conversation, your questions, your pathetic efforts to amuse her, to cheer her up. It’s as if you don’t exist, even when you’re in the same room. Over the years you learn what can trigger these silences and you do everything you can to avoid them. But when they inevitably settle in, it’s as if the world as you know it comes to an end.

Your mother’s depression, previously intermittent yet intense, has settled in with a permanence since your father left the house and your parents announced they would be getting divorced. You’ve always known she suffered from the blackest of moods. Your father has told you the story of your younger brother’s birth, and how he wanted the new baby christened Sebastian. But because your mother “wasn’t speaking” to your father throughout the period between birth and baptism, your brother is now called Paul.

Paul is the person you go to after you’ve been to the bathroom. He’s a little boy, just 4, and at three and a half years his senior it’s your responsibility to put him in his uniform, tie his tie and get him down to the kitchen where you make his breakfast. Your mother can’t tie a tie. And she doesn’t get up for breakfast. She doesn’t get up to see you off to school. The two of you eat quietly, grab your anoraks and having quietly shut the front door behind you, walk together. Recently, Paul has begun to stutter. Eventually he will be taken to a specialist who will try to find out the cause. Your father says he used to stutter a bit as a boy, too, and often imitates Paul. This drives you mad.

It’s hard to remember when you decided that you don’t love your mother. But there is a definite line in the sand when you become her fiercest critic. You hate her arbitrary moods. You hate her selfishness. You hate her neglect. Being depressed and being maternal don’t exactly go hand in hand. A depressed mother rarely puts her children first. For example, if on a Saturday morning you’ve been told to stay upstairs until your mother says you can come down, don’t (dying of boredom) find a rubber ball and start to play catch with it by yourself. Because every so often you’ll drop it. Eventually there will be a roar of rage from below. “GIVE ME THAT BALL,” she’ll yell. As you silently hand it to her, she will shout in your face, “GET DRESSED! AND GET DOWNSTAIRS!”

You’ll put on your clothes and creep down to the hallway with Paul. The two of you will half run, struggling to keep up with her as she marches rapidly and in silence out of the house and into Hyde Park about 10 minutes away. As you cross the street into the park she’ll hurl the ball into the trees.

“Go find your ball,” she will say. “And get lost.”

Having a depressed mother is an excellent way to turn a child into a liar. It’s completely against your nature, but some instinct in you makes you aware that there are some things your mother just can’t handle. So you lie by omission — you don’t tell her a lot of the fun things you do with your father. You’re hardly aware that you do this, until a few years later when Paul tells you he finds it easier to lie than to tell the truth. He’s more used to it.

Is it the lying that causes you anxiety? Or is it the general atmosphere in the house? Anxiety is the air you breathe, and it constantly affects how your body works. You’re supposed to put your light out at 7:30 at night, but sleep doesn’t come easily now, so you put your lamp under the covers and read for another two hours or so. Sometimes when you have to go to the bathroom you are too scared to, so you have accidents. You throw up from nerves. You watch yourself as if from a distance, interested in the experience, making a mental note of it.

You make mental notes of everything. (Having a depressed mother is great training for a journalist.) You note when the fridge is empty to get your mother to call the grocers. Your first experience of actual note-taking is when you decide to make shopping lists for her. You see when the laundry hamper is three-quarters full so you can start encouraging her to get the washing done. When she ignores you and you run out of clean underwear, you turn your dirty underwear inside out.

Routine is extremely important to children of depressed mothers. The clock becomes the nanny. Any deviation from a schedule is not to be allowed. The moment tea is over you take Paul upstairs for bathtime. You lay out your grubby clothes for tomorrow, and you brush your teeth. You go downstairs to say goodnight to your mother, now in her best mood of the day. There is a drink in her hand. She laughs as she allows the two of you to jump on her bed.

Then she says goodnight, and up you go to bed where you read about jolly red-cheeked children with fathers who smoke pipes and mothers who bake pies, wearing aprons over their tweed skirts, until you fall asleep.

Emma Gilbey Keller is a journalist and author who is working on a memoir about her experience of motherhood, from which this essay is adapted.


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Frequent Moves During Childhood May Be Bad for Health



Changing residences frequently in childhood may be bad for your health.

Using Danish government health data, researchers cataloged various adverse events — suicides or suicide attempts, violent criminality, mental illness, substance abuse, psychiatric diagnoses and premature death — in 1,475,030 Danes born from 1991 to 1997. Then they correlated these problems with the number of times each person had moved before age 15.

They followed the group through their early 40s and found that the likelihood of every one of those adverse outcomes tended to rise the more someone moved in childhood. Contrary to the researchers’ expectations, the associations persisted in both lower and higher socioeconomic groups.

The study, in the American Journal of Preventive Medicine, controlled for age, sex, parental age, degree of urbanization and history of mental illness in a parent or sibling. Although these factors had some influence, the separate effect of moving was still apparent: the more moves, the greater the number of psychosocial problems.

“We don’t want to create blame, where people start saying, ‘If only we hadn’t moved…’” said the lead author, Roger T. Webb, an associate professor in epidemiology at the University of Manchester in England. “We can’t say that there is a causal relationship” between moving and negative outcomes.

“The main thing is to understand how this group of young people can be so adversely affected across so many aspects of their lives,” he said.

Where Listening Is the New Lecture


Credit iStock

Mara was one of my best students; she was reliable, dedicated and truly loved to learn. One day, at the end of seventh grade, she informed me she’d be dropping my Latin class for her eighth grade year so she could have an additional study hall, time she needed to finish her other school work and participate in extracurricular activities. I signed off on her request, but I also sensed that the explanation she gave was not the whole story. Weeks later, she asked to meet with me and, voice shaking, admitted she had dropped my class because she did not feel as if her time was being well spent because she was not learning much.

As she laid my failings bare, my mouth opened, defense at the ready. When I began to speak, however, she looked me in the eyes and thanked me for listening to her.

That’s when I shut my mouth and realized I had not been listening to her at all, not for the entire year she’d been in my classroom.

If I had been listening every day, instead of just this once, her confession would not have been news. If I’d been using strategies focused on her learning, rather than my teaching – heck, if I’d just asked, I would have known she wasn’t learning.

I write about education through the lens of my own teaching, so many of my most grievous errors are Google-able, available for public consumption for as long as the internet shall live. Horrifying on a personal level, yes, but I believe teaching mistakes laid bare are a good thing for education at large.

Anyone who has managed to stick it out in the classroom for more than a year has committed serious errors. Teachers lecture, even when evidence shows lecturing isn’t effective teaching. Teachers favor certain students over others based on race, behavior or personality, even when research reveals that supportive and positive teacher-student relationships form the foundation of learning and school engagement, especially for students at increased risk of educational failure.

Letter grades, sexist dress codes, homework, institutional racism and high-stakes summative tests have stood as America’s educational status quo for hundreds of years, but handing these artifacts down to the next generation without questioning their propriety or utility is, put bluntly, bad teaching.

I, like many other teachers, have also swung too far, too fast, in my yearning for magic, silver bullets. Because I like to poke the sacred cows lazing around my classroom, I adore reading education clickbait, articles that trumpet the exciting promise of new findings. When a study emerged in 2014 on the deleterious impact of excessive classroom decorations on kindergarten learning, for example, I was tempted to purge my classroom of my carefully curated yet distracting maps, poems and student art. Fortunately, I’ve learned to stop, take a breath and consider whether the finding at hand was simply interesting (this one was) or something tried, tested, ready to be deployed with all deliberate speed in classrooms across the country (it was not).

A willingness to embrace new methods is admirable, particularly when current ones are not working, but education is a big ship to turn around, particularly when it is moving full steam ahead in the wrong direction.

Despite American education’s failures, missteps, errors of judgment and blunders of best intentions, I remain optimistic about where we are headed, both as a profession and as a nation. No, I’m not naïve; I started teaching 18 years ago and have committed or witnessed many of these blunders firsthand. Rather, I remain optimistic because I’ve also spent three years on the road meeting teachers, school counselors, administrators and school board members, and I know how much they care about their students.

Education may seem adrift right now, what with deeply entrenched debate over national versus local control of standards, the utility and fairness of standardized assessments and the economic and social worth of teachers. But at the center of much of this conflict, we all have the same focus: the students.

I believe our shared compass bearing will help us get this ship pointed in the right direction, toward a place where learning trumps expedience, knowledge confers power and listening is the new lecture.

Jessica Lahey is an educator, writer and speaker and the author of “The Gift of Failure: How the Best Parents Learn to Let Go So Their Children Can Succeed.”

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Phone-Sick at Camp


A camper writing a letter at Camp Walden in Diamond Point, N.Y.

A camper writing a letter at Camp Walden in Diamond Point, N.Y.Credit

Leaving for sleepaway camp is, for many children, a major step toward independence. Today, when cellphones keep parents and children in nearly constant contact, the fact that most camps have phone-free policies makes breaking away even more of a challenge.

“Camp-age kids, by even 10 or 11, are used to texting and being in frequent contact with their parents,” said Christopher Thurber, a clinical psychologist who focuses on youth development and summer camp. “How we communicate has changed the nature of attachment, and it complicates the separation that kids and parents go through,” he said.

According to a Pew Research Center study, teenagers send and receive an average of 67 texts per day. Kids are on their phones in school, in restaurants, on vacations and even in bed. For many, sleepaway camp remains one of the last oases, largely untouched by technology.

Yalda T. Uhls, author of “Media Moms & Digital Dads” and a child development expert with Common Sense Media, conducted a study showing that sixth graders who spent just five days at a tech-free sleepaway camp developed greater understanding of real-world interpersonal communication cues, including a better ability to read facial expressions, make eye contact, and interpret tone of voice and other prompts, such as posture and keeping an appropriate spatial distance with others.

“Camp is a sacred space to unplug and be able to learn independence and social skills,” Dr. Uhls said. “It’s really important to put devices down and practice the art of face-to-face communication.”

Putting down the phone can be at least as hard for the parents, who are often anxious about separating from their children and are used to constant check-ins, whether they are in the next state or the next room. We may complain that our children are always on the phone but “the reality is that we want that instant access to our children,” Dr. Uhls said.

Corey Dockswell, the director of Camp Wicosuta, a girls’ camp in Hebron, N.H., said the no-phone rule can be tough for parents. “They’ll say, ‘I’m used to talking to her all the time,’” she said. “It’s a steep learning curve for them.”

When Carrie Irvin, president of a nonprofit in Washington, D.C., decided to send her two daughters to Wicosuta, it was a difficult transition. “I have a really hard time dialing it back but I needed it. It was so important for them and our relationship, and I’m grateful that camp made me do it,” she said.

With this constant communication, children seek their parents’ guidance and emotional support even when they are not together, leaving fewer opportunities to develop their own confidence and internal compass for decision-making. Wendy Mogel, a clinical psychologist and the author of the parenting book “The Blessing of a Skinned Knee,” tells the story of a college student at a salad bar who texted her mother to ask if she liked ranch dressing, rather than testing it herself. Such dependent relationships can rob children of the chance to trust and believe in someone else besides their parents. Creating bonds with others is one of the most important benefits of camp, and it is more likely to happen without the electronic connection to home.

At Camp Walden in Diamond Point, N.Y., “we talk about phones all the time. It’s a huge change in their life,” said Lauren Bernstein, the owner and director. And campers aren’t the only ones unplugging. Counselors and staff members are allowed to use phones only during their time off, so campers rarely even see a cellphone. “It’s important that our entire team live like the kids do,” she said. “Camp is a different world, and we want to keep it that way.”

But many camps are using workarounds, sending a daily email blast and photos of children engaging in camp activities, for example. Some also allow parents to email campers daily – printing out the messages and distributing them to campers at mail time.

To prepare to detach for camp, Dr. Thurber recommends families try one tech-free day per week over the month before camp, with no recreational screen time. “It’s good to practice some withholding from real-time digital communication and learn to not reflexively reach for cellphones,” he said.

Children and parents can get ready by drafting practice letters or journal entries with a bit more of a narrative than the brief, immediate social media contact they are used to. Counsel your child on using an appropriate greeting and sign-off and writing with adjectives that actually describe how they’re feeling rather than using emojis. The goal is to arrive at camp with those new skills in place.

Some kids say unplugging from social media is a relief. Sofia Jacobson, 12, who attends Camp Walden, said, “I love having a break from it. It’s nice to let go and not have to think about what anyone else is doing.”

Finally, parents can help their children and themselves by shifting their mind-set and creating positive expectations for cutting the electronic umbilical cord. Rather than seeing a break from technology as some sort of punishment, view it as an opportunity to be present, nurture relationships and be creative.

“The single most important fact about sleepaway camp is that children are away from their parents, where they experience their camp as their own, their camp friends as their own, and the experience as their own,” said Michael Thompson, the author of “Homesick and Happy: How Time Away from Parents Can Help a Child Grow.”

He added, “You cannot ever fully experience things as your own when your mother is looking over your shoulder, actually or electronically.”

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Early Puberty in Girls Raises the Risk of Depression


Credit Getty Images

When girls come in for their physical exams, one of the questions I routinely ask is “Do you get your period?” I try to ask before I expect the answer to be yes, so that if a girl doesn’t seem to know about the changes of puberty that lie ahead, I can encourage her to talk about them with her mother, and offer to help answer questions. And I often point out that even those who have not yet embarked on puberty themselves are likely to have classmates who are going through these changes, so, again, it’s important to let kids know that their questions are welcome, and will be answered accurately.

But like everybody else who deals with girls, I’m aware that this means bringing up the topic when girls are pretty young. Puberty is now coming earlier for many girls, with bodies changing in the third and fourth grade, and there is a complicated discussion about the reasons, from obesity and family stress to chemicals in the environment that may disrupt the normal effects of hormones. I’m not going to try to delineate that discussion here — though it’s an important one — because I want to concentrate on the effect, rather than the cause, of reaching puberty early.

A large study published in May in the journal Pediatrics looked at a group of 8,327 children born in Hong Kong in April and May of 1997, for whom a great deal of health data has been collected. The researchers had access to the children’s health records, showing how their doctors had documented their physical maturity, according to what are known as the Tanner stages, for the standardized pediatric index of sexual maturation.

Before children enter puberty, we call it Tanner I; for girls, Tanner II is the beginning of breast development, while for boys, it’s the enlargement of the scrotum and testes and the reddening and changing of the scrotum skin. Boys and girls then progress through the intermediate changes to stage V, full physical maturity.

In this study, the researchers looked at the relationship between the age at which children moved from Tanner I to Tanner II — that is, the age at which the physical beginnings of puberty were noticed — and the likelihood of depression in those children when they were 12 to 15 years old, as detected on a screening questionnaire.

“What we found was the girls who had earlier breast development had a higher risk of depressive symptoms, or more depressive symptoms,” said Dr. C. Mary Schooling, an epidemiologist who is a professor at the City University of New York School of Public Health, and was the senior author on the study. “We didn’t see the same thing for boys.” Earlier onset of breast development in girls was associated with a higher risk of depression in early adolescence even after controlling for many other factors, including socioeconomic status, weight or parents’ marital status.

Other studies, including in the United States, have shown this same pattern, with girls who begin developing earlier than their peers vulnerable to depression in adolescence. Some studies have found this in boys, though it’s not as clear. But there is concern that girls whose development starts earlier than their peers are at risk in a number of ways, and across different cultural backgrounds.

“Early puberty is a challenge and a stress, and it’s associated with more than depression,” said Dr. Jane Mendle, a clinical psychologist in the department of human development at Cornell University. She named anxiety, disordered eating and self-injury as some of the risks for girls. In her studies of puberty, she has found associations between early development and depression in both genders in New York children. In boys, the tempo of puberty was significant, as well as the timing; boys who moved more rapidly from one Tanner stage to the next were at higher risk and the increased depression risk seemed to be related to changes in their peer relationships.

Before puberty, Dr. Mendle said, depression occurs at roughly the same rate in both sexes, but by the midpoint of puberty, girls are two and a half times more likely to be depressed than boys.

Some of these children may already be at risk; Dr. Mendle said that early puberty is more common in children who have grown up in circumstances of adversity, in poverty, in the foster care system. But some of it is heredity and some of it is body type and some of it, probably, is chance.

Researchers have wondered about hormonal associations with depression; Dr. Schooling pointed out that their study found that depression was associated with early breast development, controlled by estrogens, but not with early pubic hair development, controlled by androgens. “There is no physical factor that we know about that would explain this; estrogen has been eliminated as a driver of depression in earlier research,” she said in an email. “We probably need to explore social factors to seek an explanation.” They also plan to follow up with their study population at age 17.

The biological transition of puberty, of course, occurs in a social and cultural context. One very important effect of developing early, Dr. Mendle said, is that it changes the way that people treat you, from your peers to the adults in your life to strangers. “When kids navigate puberty they start to look different,” she said. “It can be hard for them to maintain friendships with kids who haven’t developed, and we also know that early maturing girls are more likely to be harassed and victimized by other kids in their grade.”

Parents should be aware of the difficulties that children may experience if they start puberty earlier than their peers, but lots of children handle early development with resiliency, and even pride.

Children who start puberty early – say, 8 instead of 12 — are faced with handling those physical changes while they are more childlike in their knowledge and their cognitive development, and in their emotional understanding of what goes on around them.

Parents should keep in mind that the same protective factors that help children navigate other challenges of growing up are helpful here: All children do better when they have good relationships with their parents, and when they feel connected at school. And we should be talking about the changes to their bodies before they happen, and make it clear that all of these topics are open for discussion.


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After a Fire, Jump-Starting a Bushwick Dojo

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Hommy Peña had just returned to his home in Glendale, Queens, late one night in March when he received a panicked call.

“You need to get here right away,” Mr. Peña, 43, recalled being told by the superintendent of the building that housed his small business. “Everything is on fire.”

For five years, Mr. Peña had operated Kanku-Dai Zanshin Dojo, a karate school, on DeKalb Avenue in Bushwick, Brooklyn. It was a modest space that shared the first floor of a wooden rowhouse with a storefront church, but he toiled to make it a community center. Every afternoon, Kanku-Dai was overrun with dozens of neighborhood children, nearly all from working-class Latino families.

Mr. Peña arrived that night to a horrific scene: Electrical combustion that had begun in the rear of the church built to a six-alarm blaze, tearing through five buildings on the block. It took over three hours for more than 200 firefighters to get it under control.

Mr. Peña watched as the flames swallowed his business. “I thought I was in a nightmare,” he said. “Karate is my life, and the dojo was the heart of it.”

Mr. Peña first learned karate as a child to fend off schoolyard bullies. For hours each day, he trained on the sidewalks of his native Santiago, in the Dominican Republic. Martial arts instilled in Mr. Peña a sense of conviction, he said, enabling him to ward off his tormentors and earn some titles.

He continued practicing through adolescence, but when his father died, he largely set karate aside. At a loss for what to do next, Mr. Peña moved to New York.

In the city he found a job at a health insurance company and started a family. Karate became a savored indulgence, squeezed in between work and child rearing. That changed when a friend asked Mr. Peña to oversee an after-school karate program at a church in Bushwick.

“I saw these Hispanic kids all bruised up from practicing on the marble floor and it broke my heart,” he said. “They wanted something better, just like I once did.”

Within months, the number of children studying with Mr. Peña expanded to about 80 from 10, so he moved the program to a more comfortable space on DeKalb Avenue. There, he developed a reputation as a neighborhood mentor, doling out wisdom along with foot sweeps and roundhouse blocks.

“Karate is about discipline and focus,” Mr. Peña said. “These kids have to know self-defense for their own security and confidence.”

The dojo became a refuge for local children and a godsend for their working parents, many of whom could not afford child care. Mr. Peña provided free robes and tried to keep prices down, sometimes entirely waiving fees for families unable to make the $70 monthly payment.

“My kids used to waste hours after school playing video games because I didn’t want them outside alone,” said Laura Jimenez, a cashier who has been bringing her children, Yoskar and Natalie, to Kanku-Dai for two years. “Here, they’ve learned so much about listening and respect.”

When the dojo caught fire, Ms. Jimenez and her children watched on the news in tears. They hardly understood the extent of the destruction: Mr. Peña had no fire insurance, and inside the dojo was expensive training equipment along with $7,000 in cash, all incinerated.

Before the flames even subsided, discussions in the community had begun about how to help. Green Fitness Studio, on nearby Varet Street, offered the group space for about six weeks, while Mr. Peña scoured the area for vacancies. He found one on Central Avenue — a 2,500-square-foot property that allowed for expanded class sizes. The rental deposit nearly wiped out his savings, Mr. Peña said, but he paid it with the help of an online fund-raising campaign.

Most of the equipment came from donations: mats from a dojo in Yonkers; décor from a sensei in Weehawken, N.J.; punching bags from a local supplier; American and Japanese flags from a printing company. Students and their parents gave the walls a fresh coat of paint. In May, Kanku-Dai was open for business once again.

On a recent afternoon, the dojo was teeming with young martial artists preparing for a belt test. In the closest thing to unison that schoolchildren can muster, the class of 30 mirrored Mr. Peña’s gestures, calling out each move in Japanese.

“Before the dojo, lots of these kids were running around after school with no guidance,” said Xiomara Contreras, watching her son, Emilio, 5. “Hommy gives them a role model.”

Before he started attending classes, Emilio was shy and lacked confidence, Ms. Contreras said, but that seems to have changed.

“One day,” Emilio said, glancing at Mr. Peña, “I’m going to be a black belt.”

EMAIL: fitcity@nytimes.com

The Kanku-Dai Zanshin Dojo is at 124 Central Avenue, in Bushwick, Brooklyn. For more information: 718-559-9349; kankudaidojo.org.


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Who Is to Blame When a Child Wanders at the Zoo?


Visitors at a bronze statue at the Cincinnati Zoo, two days after a boy had tumbled into the gorilla enclosure.

Visitors at a bronze statue at the Cincinnati Zoo, two days after a boy had tumbled into the gorilla enclosure.Credit William Philpott/Reuters

Some children are just harder to keep track of than others.

When Elodie Mailliet Storm realized her 2-year-old, Jasper, wasn’t standing with his sister at the entrance to the park at Pier 6 in Brooklyn, she suddenly knew, with sickening clarity, that her toddler had boarded the ferry to Governors Island.

But the ferry doors were closed. The boat was leaving, and the security staff refused to let her board.

“They said they would have seen him,” she said. But she knew her son, and she was sure the small boy had slipped past. She was right. When the guards finally relented, they found Jasper seated under a bench among the crowd. “I still can’t think about what might have happened,” said the Brooklyn mother of two. “He was physically capable of almost anything, but he had no concept of danger.”

Parents, of course, are fallible. But children — some more than others — are wily.

Who, if anyone, is to blame when a child wanders away? That question is at the center of a vociferous debate surrounding the case of Harambe, the majestic silverback gorilla who was shot on Saturday after a little boy climbed into his enclosure at the Cincinnati Zoo. The brunt of the online criticism has fallen on the child’s mother, who has declined to be interviewed the incident. On Tuesday, the police said that they were investigating the family’s actions in connection with the episode. There is even a petition on Change.org demanding that the parents be held accountable. So far, more than 350,000 people have signed.

But parenting experts and many parents themselves view the case differently. Not only did the child slip away from his mother – he squeezed under a rail, through wire barriers and over a moat wall – all in the presence of numerous bystanders surrounding the gorilla exhibit.

“Before you judge this mom, you have to remember that she may have taken every precaution,” said Mary Sheedy Kurcinka, author of “Raising Your Spirited Child.” Some children, she said, are just wired differently, with “a Lamborghini engine where most of us have a Chevy truck.”

Those are children who are more likely to react to their environment, to become highly stimulated and to struggle with impulse control. “They’re high energy, they’re intense, and they’re very committed to their goals,” she said. Unfortunately those goals may not be in line with those of their caregivers.

That clearly was the case of the boy at the gorilla exhibit. A witness told CNN that she heard the boy joke with his mother about going into the moat. The mother was briefly distracted by other children with her, and then “suddenly, the boy was in the water.”

For parents who are raising a risk-taking child, the story gives us pause. We know most trips out of the house require extra precautions. Closed doors and barred gates are like beacons to some kids, just waiting to be breached or climbed.

Jessica Bayreuther of Canaan, N.H., said her daughter Morgan climbed up into a machine where players try to grab toys with a claw at a Walmart in Maine when she was 2. She sat in there, victorious, for 45 long minutes while her parents, police officers and store employees searched the building. After the store had been shut down and panic was setting in, a boy playing a nearby video game pointed into the machine. “You looking for her?” he asked. Eventually, Morgan was persuaded to climb back out through the prize door (the store didn’t have the key to the machine).

Abby Vegas, a Connecticut writer, finally got a harness and leash for her daughter after retrieving her from, among other places, a hotel parking lot and a swimming pool cover. In my family, any trip to a museum involves one adult wholly dedicated to protecting the exhibits from one of our four kids – a child who once very nearly deconstructed a sculpture by the artist Joan Miró involving an umbrella, some fake flowers and a wooden stand. For that child, every new form of barrier requires a fresh reminder that indeed, what lies behind it is not to be touched.

In the case of the gorilla enclosure, Cindi Andrews, the opinion editor at The Cincinnati Enquirer, wrote this week that she initially criticized the parents for not supervising the child. But then she remembered the time she misjudged her own 18-month-old daughter’s foot speed as she approached a busy road. She chased the child down, but not before she ran in front of a car, which thankfully stopped quickly enough to avoid hitting her. “Raising a child to age 18 means maneuvering him or her safely through more than 567 million seconds,” Ms. Andrews wrote. “And it only takes one of those seconds for something to go terribly awry.”

Most parents have experienced “that second when your attention is turned, and the child darts away,” Dr. Kurcinka said. “This mother probably started her day thinking, ‘I’m going to do something special for the kids today.’ She never imagined anything like this would happen.”

Day Care Infections May Mean Fewer Sick Days Later


Credit Getty Images

All three of my children started out in day care as infants, and the day care center was, in so many ways, at the center of our lives for years. The teachers taught us most of what we knew about young children (including, I am sorry to say, the difference between well-meaning parents and truly talented professionals). The day care cohort provided my children with their close friends (who keep turning up in their high school and college classes). We even bought our house so we could live near the day care center.

But yes, there were the infections. The worst battles my husband and I had were fought when a small child had to stay home with fever or diarrhea, and we had the eternally nasty whose-work-day-is-more-important-mine-or-yours-and-just-what-makes-you-think-so discussion. On the other hand, as our children got a little bigger, the infections essentially vanished — they had nearly perfect attendance records by the time they got to kindergarten and beyond.

In a study published last month in the journal Pediatrics, researchers in the Netherlands followed a large group of children over the first six years of their lives, looking at how often doctors diagnosed acute gastroenteritis, the stomach bugs so familiar to parents; 1,344 out of the total 2,220 children studied attended day care during the first year of life. Being in day care as an infant increased a child’s risk of having acute gastroenteritis in the first year of life, but it also had a protective effect after that.

Interestingly, the protective effect lasted at least till age 6, which is as far as the study went; the children who were in day care by the age of 1 had more gastroenteritis earlier, but the non-day care children got sick more often as they got older. By age 6, children in the two groups averaged similar numbers of total episodes.

“We think if you are infected at an early age you build up immunity against these viruses or bacteria,” said Marieke de Hoog, an epidemiologist at University Medical Center Utrecht and the senior author on the study. “There is even a possibility that the protective effect we have seen will continue when children grow up — we need more research.”

Day care attendance is known to be a risk factor for upper respiratory infections, which are much more frequent than gastroenteritis — the average child may have as many as eight upper respiratory infections a year, to maybe one bout of gastroenteritis, said Dr. Timothy Shope, an associate professor of pediatrics at Children’s Hospital of Pittsburgh, who is the co-editor of the American Academy of Pediatrics book Managing Infectious Diseases in Childcare and Schools: A Quick Reference Guide,” the fourth edition of which is due out next month. And going to day care also puts a child at higher risk for the ear infections that can follow those upper respiratory infections.

In fact, the gastroenteritis study from the Netherlands was an offshoot of a larger study focused on respiratory infections in children, and Dr. de Hoog and her colleagues published an article in 2014 in which they demonstrated a similar pattern in upper respiratory infections and ear infections: Children who attended day care in the first year of life had more infections earlier and fewer later. For the early day care group, this led to more doctor visits overall, and more antibiotics.

Some infections can be more severe or more dangerous in babies, which is probably one reason children who get sick younger get more medical attention. And there can certainly be moments in those early years of day care when, even though children are not dangerously ill, parents can feel overwhelmed by the parade of runny noses and runny bowel movements.

There is a more complex relationship between day care attendance and the risk of developing asthma and eczema, where there are several other important factors, like family history, antibiotic exposure, and the risk of infection with one particular virus called respiratory syncytial virus, or R.S.V., which has been linked to developing asthma. Still, Dr. Shope said, day care attendance may protect against these so-called “atopic” diseases, which are related to hypersensitivity reactions in which the body’s immune system is overreactive, and it has been suggested that this connects to the “hygiene hypothesis,” that early exposures may be beneficial for the immune system.

There are three basic lines of prevention for bringing down the frequency of infections in day care children, and the most effective is immunization. We immunize against several of the most common organisms that cause gastroenteritis (oh, how I wish there had been a vaccine against rotavirus when my children were born — that diarrhea lasted for weeks) and also against some of the organisms that can complicate respiratory infections. But we have to get better at making sure all young children get the influenza vaccine, which unfortunately has to be given every year, since the virus is particularly dangerous to children.

Infection control is also important in day care, especially around diaper changing and hand-washing. However, there are limits to how much young children can cooperate regarding what they put in their mouths, or whether they cover their coughs. Studies show some benefit of infection control measures, but “not as much as we would like,” Dr. Shope said.

Then there is the always complex pediatric decision about who needs to stay home. Although there are very specific recommendations around diarrhea and diaper changing, for example, it’s also true that with many viral illnesses, children are infectious before symptoms develop and after they cease, while other children are infected and infectious but never develop symptoms, so the protective value of excluding the symptomatic children is limited.

I often see parents who are told their children have to stay home from day care, and I still identify with them. So does Dr. Shope. “When I’m seeing a typical parent with a child under a year who’s in child care, and they’re missing work, they’re wondering if something is wrong with the child,” he told me. “I tell them this is normal, they’re making an investment for the future, their child is less likely to be ill going into kindergarten when other children raised with less contact are more likely to be ill.”


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Your Face Is Beautiful — Do You Want It to Change?


Credit Juliette Borda

One of my daughters was born with a cleft lip. The repair, done when she was an infant, left its mark: Her face isn’t significantly different from the faces around her, but it is different. She knows it, but at 10, she cares a lot more about whether she can outpitch her younger brother than about how she looks in her baseball cap.

But now she needs orthodontic surgery, and there may be a benefit to doing cosmetic facial surgery at the same time. That means tackling a difficult subject — her looks.

How do you ask a child if she would like to change her appearance, without suggesting that something about her needs to change?

I would like to think that I’m raising a child who has absorbed all my lessons about how little our outer appearance matters compared to who we really are, but in reality, I’m raising a girl who has not yet reached her teens, in a world where magazines tell 9-year-olds what bathing suits are best for their body types. Research suggests that girls’ self-esteem plummets at around age 12 and doesn’t start heading upward again until they enter their 20s. In other words, a few short years from now, she’s likely to care about her appearance a whole lot more than she does now. But other research (and common sense) also tells us that how much emphasis our mothers put on our appearance, whether it’s our weight or our faces or anything else, affects how we feel about ourselves.

Our particular challenge might be a little unusual, but the conversation isn’t. Any parent who has talked to a child about doing something to alter the self he or she presents to the world has tried to walk that fine line between proposing a change (braces, acne medication, a healthier diet, straightened hair) and seeming to demand it — and any adult who still hears a parent’s voice judging him or her not thin enough, pretty enough, good enough knows how easy it is to get this one wrong.

“Girls tell themselves these stories about their appearance,” said Catherine Steiner-Adair, a clinical psychologist, the creator of “Full of Ourselves: A Wellness Program to Advance Girl Power, Health, and Leadership,” a program for middle-school girls and the author of “The Big Disconnect: Protecting Childhood and Family Relationships in the Digital Age.” Parents’ words and actions become a part of those stories.

“My mother wasn’t happy with her nose, so I would hear about my nose constantly,” said Jen Lancaster, a novelist and author of the memoirs “Such a Pretty Fat” and “Bitter Is the New Black.” “To this day, I can’t look in the mirror without trying to figure out, ‘Do I need to contour my nose differently today? How does my nose look today?’ This is not a conversation I should ever have with myself, because my nose is fine.”

Too often, Ms. Adair sees parents drawing conclusions from their own experience. A parent who struggled with weight worries that the weight gain many children experience as preteens may become the precursor to a life of teasing and dieting rather than just puberty.

“I tell parents, ‘it sounds like this might be more your issue than hers,’” Ms. Adair said.

The same can happen for parents who want to turn glasses into contacts, straighten or highlight a young teenager’s hair, get braces over with early or worry about girls and boys who want to wear hairstyles or clothing in a way that contradicts our vision of their gender identity. We hear the mocking voices of our own childhood.

Nancy Redd, a former Miss Virginia and the author of “Body Drama: Real Girls, Real Bodies, Real Issues, Real Answers,” says that even when a procedure seems most easily justified, if it’s purely cosmetic, parents like me should think hard before we suggest it.

“We are so arbitrary about what is attractive and what is a disfigurement,” Ms. Redd said. “Mole above the lip? Awesome. On the chin or nose or eyelid? Gross. Wide space between your two front teeth on a low-income woman in rural America? Gross. On a European supermodel? Fabulous.”

Perception, she points out, is everything.

My daughter’s nose, and her scar, and her whole face, are fine, awesome, fabulous. Some experts say it’s better not to talk about weight or appearance at all. I wish it were that simple. I’d love to take the easy way out while getting to declare it the high road. But my daughter may want to look different, and don’t think she’ll thank me for my reticence if it means a second operation when one might have been enough.

When appearance and health overlap, parents who want to talk about a child’s looks just need to be very matter-of-fact, advises Ms. Adair.

“She may not be talking about it because she’s not worried about it, or she may not want you to worry about it,” she said. She suggested that to start the conversation with my own daughter, I could remind her of times when she’s asked about her scar. Ask her if she still thinks about it, and tell her that during her surgery, “the doctors can change that if you want,” she suggested.

Parents can be similarly direct but neutral about other issues, like acne. Saying, “I see you’re getting some pimples” is a better way to preface a visit to the dermatologist than saying, “your skin looks terrible.”

When I suggested to my daughter that orthodontic surgery might give her the opportunity to make other changes, she was interested. And she had thought about her appearance, but not in the way I’d expected. After gently broaching the topic of her childhood surgery, I asked her if she wanted to change the asymmetry of her lips. She shook her head.

Instead, she asked about the symmetry of her nose, which is affected by the pull of the scar. I had never thought about that. I still suspect her upper lip will be on her list when she’s older, but knowing it was her nose she wanted to talk about guided me in asking doctors about timing and combining surgeries.

But even though she wanted answers, the consultation took us both aback. Hearing her face so bluntly discussed was upsetting for my daughter and we interrupted the doctors repeatedly, and finally steered them away from the topic. (We revisited it later, with her out of earshot.) In hindsight we should have talked to the doctor privately first. As Ms. Adair reminded me, it’s fine for parents to tell doctors: “Please do not use language that will echo in her head for years.”

In the end, my daughter’s doctors didn’t want to do anything more than remove a tooth and look around. As for her nose, they said that reconstructions done too early, while a child’s face is still growing, may have to be redone later. She didn’t seem disappointed.

For now, we’ve decided to wait and see if any additional operations are essential before we broach the topic of cosmetic surgery again. We will make health decisions for her, but we will let her decide whether she wants to undergo an optional cosmetic procedure.

And we won’t dwell on it. I don’t want my daughter’s face to look any different, and I never will. But if she does, I want what she wants — and then, I want to go back to talking about baseball.

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The Other Bathroom Wars


Credit iStock

Jane Serge remembers her father pushing her wheelchair into a men’s room in the late 1970s. “Close your eyes,” he would say, as he quickly wheeled her toward the stalls.

Today, a father who took his disabled daughter into a men’s room in a public building in North Carolina technically would run afoul of the state’s so-called “bathroom bill,” which requires that people over the age of 7 use the bathroom that matches the sex on their birth certificates. While the law is aimed at transgender people, disability advocates worry that it also could affect people with disabilities who, because they need assistance from an opposite sex caregiver or parent, also use opposite sex bathrooms.

Parents like Jennifer Eldridge-Bird of Miami, whose sons, ages 11 and 15, have autism, say their children’s disabilities require that the parent and child stay together at all times.

“They’re not very high-functioning,” she said. “If I’m going in the ladies’ room, they’re going in the ladies’ room.”

Sharisse Tracy, a mother of four in West Point, N.Y., said sending her 8-year-old, who has autism, into a shared men’s room alone is out of the question. “I wouldn’t send him in anywhere alone, let alone a men’s room,” she said.

For Laura Rossi and her 13-year-old twins, using public bathrooms became more challenging as her children have gotten older. Her son, Matt, has Tourette syndrome, accompanied by significant impairment of fine motor and social skills.

“When the twins were little and cute, there were all these smiles and nodding heads,” said Ms. Rossi, a public relations professional who lives in Jamestown, R.I.

But as they got older, she began to hear criticism when she took them into the women’s room. “Matt’s needs are invisible, and he got tall very quickly,” she said. “If there’s not a family bathroom, we got a lot of looks and comments, you know, meant for you to hear but not really ‘to’ you — like ‘this is not the boys’ room.’”

With restroom access a topic of national debate, many people with disabilities and their families are hoping that conversation extends to expanding access to public facilities for every person.

For many of the nearly one in five Americans (and about 5 percent of school-age children) with some disability, lack of access to public toilet facilities challenges their ability to take part in ordinary daily life. For some, like Ms. Serge, 46, who was born with cerebral palsy, the challenges are primarily physical.

“The stalls aren’t wide enough,” she said, quickly ticking off a list of problems she faces regularly in public restrooms in Amherst, Mass., where she lives. “If the door swings in, not out, you can’t close it once you’re in there.” The rails or toilet seats are often loose; there’s not room for her and for someone to help her and she has hit her head on a badly positioned huge toilet paper roll more than once. “And by the time I’m done, the motion-activated flush has gone off, like, 14 times.”

For others — parents of teenage and adult children with physical disabilities, some of whom use diapers, or of older children and teenagers with autism or other cognitive and emotional difficulties — the challenges have to do with their ability to assist family members.

Family members of people with disabilities say large, multi-stall public restrooms present the biggest challenge. Some large retailers now offer family bathrooms, which are ideal because they are private but large enough to accommodate multiple family members as well as wheelchairs and strollers. Individual bathrooms also work better for everyone, but space and cost constraints mean that many public spaces don’t offer them.

Some people say that if there isn’t a bathroom that accommodates the needs of disabled family members, they just stay home.

“We plan all our trips around Michael,” said Jean Lucas, whose nonverbal 7-year-old son uses diapers and a wheelchair. “Sometimes I’m in the middle of the floor, changing him while people are washing their hands.” It’s a situation the South River, N.J., mother of four does her best to avoid. “People say, oh, he doesn’t know what’s going on, but he knows. He understands. He deserves privacy.”

Eric Lipp, executive director of the Chicago-based Open Doors Organization, which advocates for people with disabilities in the travel and tourism industries, says there is a slowly growing movement to offer facilities for changing a diaper on an adult or an older child — a large, stable surface, ideally with a lift, like those designed by the nonprofit Changing-places.org

“Family bathrooms have been a really big addition for people with disabilities,” he said.

Jennifer Kasten, a mother of two daughters, one of whom uses a wheelchair, and a lawyer and special education advocate in Scottsdale, Ariz., said that creating accessible bathrooms isn’t just an issue for people who are transgender or disabled, but something that may affect all people as they age or as their health circumstances change.

“Accessibility has unintended consequences that are good for everyone,” she said, “How we think about accessible bathrooms says a lot about how we think of people with disabilities in general.”

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Parents of Deaf Children, Stuck in the Middle of an Argument


Nyle DiMarco, left, a contestant on “Dancing With the Stars,” shown here with professional dancer Peta Murgatroyd, is an advocate for American Sign Language.

Nyle DiMarco, left, a contestant on “Dancing With the Stars,” shown here with professional dancer Peta Murgatroyd, is an advocate for American Sign Language.Credit Getty Images


Credit Getty Images

A long-simmering controversy erupted this spring over how deaf children should communicate.

It started when The Washington Post ran a story on Nyle DiMarco, the deaf “Dancing With the Stars contestant who is also an advocate for American Sign Language (ASL). When Meredith Sugar, president of the Alexander Graham Bell Association for the Deaf and Hard of Hearing, retorted that ASL was becoming obsolete in light of better hearing aid and cochlear implant technology, the arguing went public. But that debate was really just the latest manifestation of a longstanding conflict among deaf people and parents of deaf children: Should children be fitted for hearing aids and taught to speak, or should they use sign language? Or a combination of both?

As the parent of a 2-year-old whose hearing loss was recently diagnosed, the arguments only heightened my anxiety about how to address my son Sam’s needs. After his diagnosis, Sam’s doctors assumed he would get hearing aids, which he would need for the rest of his life. ASL was not mentioned as an option. Because Sam has residual hearing — his loss is mild in one ear and moderate to severe in the other — I went along with their recommendation.

One friend, a speech therapist whose brother is deaf, told me not to sign at all with Sam because he would use it as a crutch instead of learning to speak. This made sense to me, and for a while after Sam was aided, his therapist, a teacher of the deaf, focused on his listening and speaking skills. The hearing aids gave him more access to sound, but he still had trouble processing all that new information and figuring out how to replicate it through spoken language.

Although his speech did improve, the frustration I continued to see in his face when he tried to tell me something was heartbreaking. Tantrums were frequent. Sam started coming up with his own signs, such as a chomping motion with his arms when he wanted to wear his dragon shirt. He was searching for any way to communicate.

So, I asked his therapist about incorporating sign. But instead of using ASL, which is its own language with a grammatical structure different from that of English, she advised “signed English.” This incorporates ASL signs but in a way that mimics spoken language. Although some children are taught to be bilingual in ASL and English, ASL is not designed to represent English directly. The benefit of learning signed English, Sam’s therapist said, is that he could sign and speak at the same time. Plus, when it comes time to learn to read, it’s not as much of an adjustment. “Learning ASL and then learning to read English is very tough,” she said. “It would be like learning Chinese.”

I’ve come to think of signing as a tool for Sam to learn English. The majority of the world is hearing. Only two to three children out of 1,000 are born with hearing loss, and more than 90 percent of them to hearing parents. Those who say not teaching ASL to hard-of-hearing children is language deprivation only vilify parents who are trying to find a bridge between the hearing and deaf worlds.

And it’s hard for parents like me to know which world their hard-of-hearing child should be in – or even what words to use to talk about it. Because Sam had some hearing I hesitated to refer to him as “deaf.” Many deaf people feel the term “hearing impaired” implies a deficit and focuses on a disability, so I settled on “hard-of-hearing.” But after talking with an advocate for deaf children in the New Jersey Early Intervention System, I realized there is not a clear delineation between deaf and hearing — it’s more like a spectrum. “When you say ‘mild hearing loss,’ people think it’s easily fixable,” she told me. “In fact, children with mild or moderate loss sometimes have an even more difficult time because they can hide their inability to hear.”

Hearing aids aren’t perfect, and certain situations, like a noisy classroom or restaurant, will still be difficult. As an alternative, many in the Deaf community — who capitalize the “D” to indicate a sense of unity and celebration — embrace their lack of hearing as an identity, avoid hearing aids and amplification altogether and focus on ASL. In this sense, being Deaf is more than a specific state of hearing; it’s being part of a specific culture that’s inclusive of those with mild as well as profound hearing loss. Many Deaf people feel well-meaning parents are pushed by doctors, audiologists and groups like AG Bell to try to make their children fit in with the hearing world through technology. But as Sam’s audiologist said to me, “Lots of people have glasses, so why should hearing aids be thought of any differently?”

Although in principle she may be right, hearing aid use in children, which requires years of visits with doctors, audiologists and speech therapists, remains controversial. Sam’s doctor told me that some in the Deaf community would think it’s “child abuse” for her to perform cochlear implant surgery, the next step in technology if over-the-ear aids aren’t effective. “They’d have me thrown in jail,” she said. This anti-technology attitude means that many parents who choose aids or implants wonder where their kids fit in. They’re not quite hearing, not quite deaf, and maybe not even Deaf.

Instead of a united front advocating for deaf and hard-of-hearing children, I’ve found a community struggling with internal conflict. As in politics, extremists on either side have created an environment that makes it hard for those in the middle to feel comfortable discussing the issues. I’m making decisions for my son, but I don’t know whether he will agree with them when he’s older. But what would help parents the most is a community that could talk openly to work through the options without judgment or dogma. What would best benefit my son — and me, in making choices for him — is better support for whichever decision we make.

Tina Donvito is a freelance writer who blogs at foggymommy.com.

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Parents Shouldn’t Feel Guilty About Training Babies to Sleep



When my first child did not dependably sleep through the night, my parents were puzzled. My mother told me that to the best of her recollection, neither I nor my siblings had ever been troubled by night waking. I suspected that, back in the 1950s and ‘60s, they might have let us cry it out, but they didn’t recall. There might have been some difficult nights, but what was the big deal?

In our era of more anxious parenting, there’s a lot of debate about what has come to be called sleep training, that is, behavioral techniques for getting a baby who is 6 months old or older to fall asleep alone and sleep through the night. The debate comes when these techniques involve some periods of crying and protest on the baby’s part. Parents (and experts) who believe in sleep training feel that babies can develop “self-soothing” skills: learning sleep cues that help them comfort themselves and fall back asleep when they wake at night — as we all tend to do. Opponents of sleep training, many of whom are more generally committed to “attachment parenting,” say that in fact sleep training results in “learned helplessness,” with infants making the agonizing discovery that no matter how hard they cry, no one will come.

In a study published this week in the journal Pediatrics, 43 infants in Australia, 6 to 16 months old, all healthy, but identified by their parents as having sleep problems, were randomized to three different groups. In one group, the parents tried graduated extinction, the technique in which babies are allowed to cry for short, prescribed intervals over the course of several nights. The second group tried a technique called bedtime fading, in which parents delay bedtime in 15-minute increments so the child becomes more and more tired. And the third group, as a control, was just given sleep information.

The researchers measured the babies’ stress by sampling their levels of cortisol, a hormone indicating stress, and also looked at the mothers’ stress; 12 months after the intervention, they evaluated parent-child attachment and looked at whether the children had emotional and behavioral problems.

“What we were interested in is this hypothesis that there are these long-term consequences from doing something like graduated extinction,” said Michael Gradisar, an associate professor of psychology at Flinders University in Adelaide who was the first author on the new study.

Both sleep techniques – graduated extinction and bedtime fading — decreased the time it took children to fall asleep and graduated extinction reduced night wakings, compared to the control group. All the salivary cortisol levels were within the normal range in all three groups, but the afternoon levels in the two sleep training groups declined over time more than the controls. And there was no difference among the groups, 12 months later, in the measures of the children’s emotional and behavioral well-being.

Although critics of graduated extinction believe that strategy disrupts parent-child attachment, Dr. Gradisar said: “We couldn’t find any differences. The more studies we get, the more confident we can feel that this is actually safe to perform.”

This research builds on a follow-up study that appeared in Pediatrics in 2012, which looked at a large group of Australian children who, as babies, had participated in a controlled study of the effectiveness of behavioral sleep techniques. The original study, from 2006, had found that these techniques were effective both in reducing parents’ report of sleep problems in their 10-month-olds and also in reducing maternal depression, which has been linked to children’s sleep issues.

The 2012 research looked at those children at age 6, and checked out their mental health, stress regulation, sleep and a variety of measures of the parent-child relationship.

“We measured cortisol in saliva,” said Dr. Anna Price, a postdoctoral researcher in pediatric psychology at Murdoch Childrens Research Institute in Melbourne, who was the first author. “We also looked at parents’ mental health as well, all the effects the early program might have had on their later development and behavior, and the two groups looked very similar on all the measures.” The researchers found no differences between the children whose parents had been advised about the behavioral sleep techniques and the controls.

Another study of infant cortisol levels, published in 2012 in the journal Early Human Development, has been cited as showing that these behavioral techniques can be highly stressful for infants; it suggested that babies might be in distress even though they were not crying. Wendy Middlemiss, an associate professor of educational psychology at the University of North Texas, who was the first author on that study, said: “You have to be responsive. You can’t let them cry for long periods of time.”

But how cortisol is measured and interpreted is thus at the very center of this debate. Dr. Price and Dr. Gradisar were both among the authors of a letter responding to the Middlemiss article and challenging the cortisol methodology.

All these researchers agree that parents shouldn’t do anything that makes them uncomfortable; parents know best what their children need. But not-so-subtly, there’s a sense on one side that parents feel pressured and guilted into leaving their tiny babies to cry and cry at night, and on the other, that parents feel pressured and guilted into not letting their children cry for even a moment. And both may be true.

If what we really mean is, parents should do what they’re comfortable doing, and our job as pediatricians and pundits is to help them feel confident in their parenting, we have to accept that different families will make different reasonable choices.

There’s some good evidence that the various methods of “sleep training,” none of which should involve letting a small infant cry for hours in a dark room, work for many children and many families. There’s no evidence that they do lasting damage to the child or the parent-child bond and, in fact, some reassuring evidence that they don’t.

There also doesn’t seem to be evidence that you do harm by deciding to forgo “sleep training” and waiting for the child to outgrow the night waking — as long as that doesn’t damage your marriage or your mental health.

As a pediatrician, I think about the baby, but I also try to take into account how the parents are doing. I sometimes wonder how the people who are most strongly opposed to any form of sleep training would feel about having their children’s teachers, or doctors or bus drivers, coming to work sleep deprived after really disrupted nights. Sleep matters, as we have learned to acknowledge in medical training. Babies matter, and so do parents.

What your baby needs most is a loving family, which ideally includes parents who are enjoying the adventure. And no expert can tell whether you are enjoying the adventure better than you yourself.

See you in the morning.


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What American Parents Can Learn From Chinese Philosophy



Here’s the conventional wisdom about raising kids in modern-day America. Teach them to know who they are. Encourage them to think big and to aim high. Show them how to play to their strengths and plan a route to future success.

But there is a better way to turn a child into a flourishing adult, one based on just about the opposite of everything we think we should do. This “new” way is actually very old – over 2,000 years old — and is inspired by the wisdom of Chinese philosophers including Mencius, Confucius and Laotzu.

Consider what they might say if they were raising today’s children:

Stop Looking For Your Passion

I used to believe that even in infancy, I could get a sense of my four children’s personalities in order to raise them the way that was best for them. Cultural mores reinforce the notion that self-exploration is important, especially in adolescence, when teenagers are figuring out who they are. By the time they fill out the Common Application for college admissions, they’ve learned how to distill the core of themselves into 650 words. And central to that core identity is their passion, or what makes them unique.

But Chinese philosophy has taught me that that seeking who you are and what you love is dangerous. When you look within to identify yourself, including your proclivities, your strengths and your passions, what you’re really seeing is a snapshot in time. When I encourage my children to figure out who they are and to be true to that, I am limiting them to who they think they are at this moment, without understanding how much people change.

Chinese philosophers correctly described human beings as complex, multifaceted beings bumping up against other complex, multifaceted beings all day long. We shift in every interaction and every experience and are developing all the time. I am now trying to teach my children to see themselves as endlessly fluid people who have the ability to develop new interests and to change.

Keep Playing Pretend

We raise our children to be sincere, to express themselves honestly, to be in touch with their deep and true emotions, and to have a healthy skepticism for anyone or anything that seems “fake.” But the Chinese philosophers knew that playing pretend serves an important purpose, not just in childhood but for adults as well.

Pretending to be other than who we really think we are is similar to a Confucian “as if” ritual. These are the daily moments during which we briefly become a different person, like when I greet an acquaintance on the street with a smile even though I was just fretting over a difficult conversation I had with a colleague. By viewing these small “as if” moments as an exercise in breaking from who we think we authentically are or what we are sincerely feeling in that moment, I am not just teaching my children to be polite or nice. I’m teaching them not to fall into the trap of always being true to who they are.

Live Life as a Series of Ruptures

As children learn what they are good at and what they aren’t, what they love and what they don’t, they gradually winnow out the things that seem irrelevant and uninteresting. My oldest plays soccer and reads history books, and no longer has time to explore drama. And who can blame him? In an increasingly pressurized and anxiety-ridden environment, playing to your strengths seems like the most sensible and efficient way to head into a future career.

As I read Mencius’s writings, I had an epiphany: how efficient is it, really, to make firm plans for a future career, only to have to shift gears years from now when you wake up and find you are living a life that is the result of decisions made by the person you were at only 17 years old?

Encourage your offspring to pay attention to everything, to do things they’re not good at precisely because they’re not good at them.

See the Merits of Self Restraint

American education, with its focus on class participation and its valorization of extroverted leaders, socializes our kids into becoming proactive, expressive and assertive learners. Our children learn that the self-advocate, the one who puts himself out there, is more likely to garner club leaderships and glowing teacher recommendations, thus setting him or her on the path to future success.

But when we emphasize self-assertion, our kids become trained to always see situations in terms of power balances, to calculate how they can jump in to any situation to show the world who they are. This sort of training cuts directly against the Chinese philosopher Laotzu’s concept of “strength through (seeming) weakness,” which rests on the basic truth that human beings are all affected by one another. A self-aggrandizing but clueless student fails to recognize how his actions breed irritation, resentment or even contempt from fellow classmates. But there is an advantage in being someone who is not always trying to dominate the room.

While I once worried that my children’s quieter natures would prevent them from being seen as equal players on life’s stage and fretted over how to teach them to be more assertive and stand up for themselves more, I teach them differently now. I tell them that the greatest impact can be had when they understand how to shift situations by paying attention to the emotions and relationships that undergird every situation.

Attend to the Mundane

The Chinese philosophers saw the world as one of endless, shifting relationships. That’s why they emphasized that we have influence over the trajectory of our lives when we focus not on who we are, our plans for the future, and self-assertion, but on learning how to relate well to others.

Caring for one another is hard work. It requires endless awareness, adaptation and responsiveness. But it is one of the most important and rewarding things we do. This is not just how our children will become better people and live better lives. It is how they can create a better world.

Christine Gross-Loh is the co-author, with Michael Puett, of “The Path: What Chinese Philosophers Can Teach Us About the Good Life,” from which this essay is adapted.

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Supporting Children Who Serve as Caregivers


Credit Paul Rogers

In the normal scheme of things, parents and grandparents take care of children when they’re sick or need help or sustenance. But in well over a million American families, this pattern is reversed, with children as young as 8, 9 or 10 partly or fully responsible for the welfare of adults or siblings they live with.

They may have to shop, prepare meals, clean house, do the laundry and tend to the hygienic needs of family members unable to care for themselves.

At the same time, these children must go to school, do their homework and attempt, but usually fail, to participate in nonacademic activities like sports and friendships widely recognized as important to well-rounded development.

Connie Siskowski, a registered nurse in Boca Raton, Fla., knows well the challenges these children face. As an 11-year-old with divorced parents, she began living with her grandparents in New Jersey. Her grandfather was, as she put it, “my hero, the only person I was close to, and it was my honor to help him with personal care issues.

“I slept in the living room so I could be near him in case he needed something during the night. One night I went into the bedroom to give him his medicine, and I found him dead of cardiac disease.”

There was no support system to help Connie, then 13, deal with the emotional fallout from this loss and put the pieces of her life back together. For years thereafter, she said she made poor personal choices, including three bad marriages. Her only good choice during this time: going straight from high school to nursing school, then getting advanced degrees in cardiac nursing and health care administration and a Ph.D. in educational leadership.

After her third marriage failed, she finally found her emotional equilibrium through counseling. She married a fourth time to a man who loves and respects her and, with his encouragement, felt compelled to do something to help caregiving children and “prevent some of the repercussions I experienced.”

In 2006, Dr. Siskowski started the Caregiving Youth Project, dedicated to helping young caregivers of ill, elderly or disabled family members. With support from grants and private donations her organization, now called the American Association of Caregiving Youth, works with school districts to identify children who need help navigating the competing demands of caregiving and school and still find some time to be a child.

Thus far, more than 1,000 children in Palm Beach County, Florida, have benefited from the support the organization offers to children 18 or younger who regularly help relatives with “physical or mental illness, disability, frailty associated with aging, substance misuse or other conditions.”

As many as 1.4 million American children from ages 8 to 18 care for a parent, grandparent or sibling with a disability or illness, the American Psychological Association says, but it remains largely a hidden problem. Parents are often too embarrassed to tell schools how much they depend on their children, and caregiving children fear being taken away from their parents.

Many of these youngsters come from low-income, often single-parent households. They often fall behind in school, suffer from sleep deprivation and struggle with depression, anxiety and stress, said Gail G. Hunt of the National Alliance for Caregiving. She said 58 percent of these children “are too worried to concentrate on their schoolwork,” yet few tell their teachers about their responsibilities at home. A 2006 study by Civic Enterprises conducted for the Bill and Melinda Gates Foundation found that 22 percent of high school dropouts in this country leave school to care for a family member.

Dr. Siskowski’s Caregiving Youth project, now at eight middle schools and nine high schools in Florida, offers classes on topics like coping with stress and anger and managing finances. Along with home-care demonstrations and respite care, the project sponsors field trips, overnight camps and other recreational and social activities. They hope to expand the program to other schools throughout the country.

Schools are made aware that the children’s responsibilities may be reasons for incomplete homework, absenteeism and poor academic performance. The project offers in-home tutoring and study programs and even provides computers and printers for children who can’t get to a library. After four house fires resulted from youthful cooking attempts, the association began distributing slow cookers and fire extinguishers.

Perhaps most important, the children learn that they are not alone and that there is help available. “The kids feel valued; they learn what love is, and it flips the anger and frustration they may otherwise feel,” Dr. Siskowski said. The project stays in their corner until they graduate from high school.

One beneficiary was Nickolaus Dent, featured on CNN in 2012. When Nickolaus was 11, his father died and he became primary caregiver for his mother, sick with H.I.V. The boy was responsible for the grocery shopping and cooking, cleaning and laundry. He made sure his mother took her medication, got her dressed and sometimes even helped her bathe.

He said he considered caring for his mother “a bigger priority than going to school.” But with the organization’s help, he managed to do both, getting A’s and B’s. His mother died in December 2012, and Nickolaus expects to graduate from high school this year.

Others now being helped include Julianna Doran, a 14-year-old ninth grader, and Alecia Locke, a 13-year-old seventh grader, both in Boca Raton. Julianna helps to care for her 10-year-old brother who has cerebral palsy. “He can’t walk; he can’t control his muscles; he’s dead weight,” she said. Julianna’s parents have serious back problems, so it’s largely her job to lift and carry him.

Alecia, whose parents are divorced, spends weekends with her dad, whose mobility is seriously limited by multiple sclerosis. She does his laundry and dishes, cleans floors, assists with his scooter and fills the gas tank.

Dr. Siskowski knows much more help for young caregivers is needed now and in the years ahead. “With the increase in technology, more people are living longer and being cared for at home,” she said. “There are more multigenerational households, more women working and more gaps in the health care system that are being filled by children. We need to get these kids recognized as a vulnerable population at risk of dropping out of school.”

She added, “Society can benefit from investing in them. Children who graduate from high school have the potential of earning $10,000 more a year. And many of these kids want to get into health care, which needs all the help it can get.”


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Learning to Live With a Child’s Allergies


Credit Andrew Scrivani for The New York Times

When your older daughter is a toddler and you are pregnant with your younger daughter, your husband says, “Every Friday, we should have family pizza night.” Four months later, you give birth to a daughter who is allergic to milk (meaning also to cheese), as well as to eggs, tree nuts, peanuts and maybe buckwheat and flaxseed. Very early on, certain foods leave rashes around her mouth or make her vomit, so you stop giving them to her. When she is 8 months old, her sister spills ice cream on her arm. Red bumps immediately rise in the places the ice cream touched.

Your daughter’s allergies are officially diagnosed just before she turns 1, and for her first birthday, you make her a “cake” out of puréed sweet potatoes topped with coconut yogurt (you are now well-versed in the debate about whether coconut is a tree nut and think it’s not). She feels about this cake the way most anyone would, which is that it’s gross.

You scour the Internet for recommendations on how to handle multiple food allergies. You find horror stories about children dying of anaphylaxis brought on by a single bite of the wrong thing.

You read every ingredient in everything you buy at the grocery store, even when you buy more than one package of the same thing, even when you buy the same product week after week. You come to know certain products so well that when they get a new ingredient, it’s like a friend getting a haircut.

You talk to a fellow “food allergy mom,” the friend of a friend, who explains that your family shouldn’t go out for ice cream because even if your daughter gets sorbet, the employee will use the same spoon to scoop it that he used for someone else’s cone of pistachio; and your daughter shouldn’t eat jelly at another family’s house because that family dips their peanut buttery knives in the jelly when making sandwiches. You have always been such a good worrier, but these are things you never thought to worry about.

You stop going to restaurants as a family; you stop bringing home carryout, except occasionally and furtively, when you and your husband take turns eating it standing up in a corner of the kitchen (his preference) or sitting on the upstairs bathroom floor with the door closed (your preference).

You never leave the house without Epi-Pens.

Your husband, who barely cooked before you had children, matter-of-factly learns to make vegan doughnuts and vegan waffles and vegan whipped cream.

Because it’s medically recommended that you keep exposing your older daughter to the foods your younger daughter is allergic to, you go once or twice a week with your older daughter to diners or bakeries or Vietnamese restaurants. These are delightful outings — your older daughter is excellent company and loves trying new things — at the conclusion of which you scrub your hands and hers, at the restaurant and again at home, with a vigor appropriate for performing surgery.

When your daughter starts preschool, you burst into tears at the meeting with her teachers where you discuss how to handle snack time.

On Halloween, your daughter goes trick-or-treating but you carry along a bag of candy for her to choose from. Your daughter takes her own cupcakes to birthday parties and her own snack on play dates.

You rarely travel as a family; when you do, you pack loaves of bread and jars of sun butter in your suitcase. You FedEx soy milk to Idaho.

You wonder if it’s all because you ate too many peanut M&Ms when you were pregnant. At the same time, you decide that if you had it to do over again, the minute your daughter emerged from the birth canal, you’d have chewed up a peanut and spit it from your mouth into hers, because you’ve heard that pediatricians now endorse early exposure to nuts.

Other things you’d have done to prevent her allergies, if only time-travel were possible and if only you’d known: gotten a dog; renounced your dishwasher; become Amish.

You lie awake at night fretting about what will happen when your daughter is old enough for sleepovers, or for kissing people, or for college.

Those parents who complain about not being able to send their kids to school with the PB&J they love? Those airplane passengers who groan audibly when the flight attendant announces they won’t be serving peanuts today? Those codgers who say allergies didn’t exist when they were young and it’s just a bunch of helicopter parenting? You detest them.

But you feel enormous gratitude towards the parents who write “sun butter” on the plastic bags they send sandwiches to school in, or who go over the exact menu for their kid’s birthday party and show no irritation when they say, “Bagged carrots,” and you ask, “Bagged carrots that you’ll buy bagged or bag yourself?”

You start going as a family to an ice cream parlor where your older daughter and your husband get ice cream and you and your younger daughter bring coconut bars from home. You frantically wipe down the table and chairs before you sit. You know this excursion would probably seem depressing from the outside; secretly, from the inside, you consider it slightly depressing. But mostly you consider it festive and triumphant. Now your daughter knows what an ice cream parlor looks like!

You understand that into every life a little rain must fall but just wish the rain had fallen on you rather than your child. Obviously, to some extent, it is falling on you. But you wish it had fallen on you completely.

As much trouble as her allergies are, you never wish your daughter was anyone other than her hilarious, stubborn, singing, dancing, mermaid-obsessed, food allergic self.

And even if you cannot master allergies, it turns out that you can make cookies that are both safe for your daughter and delicious.

Allergy-Friendly Cookies

For a family with a child with allergies to milk, eggs and nuts, this is a go-to recipe.

Curtis Sittenfeld is the author, most recently, of the novel “Eligible: A Modern Retelling of Pride and Prejudice.” This is adapted from an essay in “The Artists’ and Writers’ Cookbook: A Collection of Stories With Recipes,” edited by Natalie Eve Garrett, to be published this fall.


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What Should You Pay for a Child’s Guitar (Or Any Musical Instrument)?


Credit iStock

It should have been a simple enough request. My 10-year-old, after several years of piano and voice lessons, had asked for a guitar.

But what to buy? I posed the question to my Facebook friends. Full-size or smaller? Acoustic or electric?

A couple of guys from the best campus band from my college days suggested the Baby Taylor, a three-quarter size (also known as parlor-size) acoustic guitar made by the El Cajon, Calif., company that the likes of Taylor Swift and Jason Mraz count on for instruments. A new one generally sells for around $329.

But then I heard from my friend Craig Bromberg, the father of 11-year-old guitar-playing twins and a serious musician himself. He let me have it for even considering buying a brand-new guitar. “I for one can’t stand the idea of kids with fancy instruments before they have even taken a single lesson,” he wrote.

He had a point. I’ve devoted a decent chunk of my professional life of late to trying to talk parents who have more money than average out of overindulging their kids. When it comes to cars, a shiny used one is generally the best choice. As for fancy mobile phones, get a dumb phone with basic voice and text service or let them pay the difference between that and the roving Internet access and shiny hardware they crave.

But musical instruments (of all sorts – not just guitars) are tools for learning, and that makes them different from cars or phones. Many forms of athletic gear for older children – tennis rackets, lacrosse sticks, gloves for baseball or softball – are similar. Even so, I realized that in considering my child’s request for a guitar, I got caught up in all the usual aspirations we have for our children, as well as my own memories and regrets about my musical training.

The lesson: We ought to put every object of child desire through its own wants-versus-needs test, one that inevitably ends with a question about how much is enough.

When I called up the people at Taylor Guitars to ask them how much guitar a 10-year-old truly needs, they put me in touch with Andy Powers, who is in charge of guitar design for the company. A parent and former guitar teacher himself, he does not necessarily default to his own company’s instruments when recommending a first guitar to other parents.

“I say that the first thing we want to do is get the kids an electric guitar,” he said, because electric guitars are often easier for beginners to play. His company doesn’t make very many of them and none at the entry level.

And he offered advice for helping a child stick with the instrument. “The first thing you want to teach them is their very favorite song,” he advised.

But how much should you actually spend? Mr. Powers outlined the two approaches he hears about most often. The delayed gratification theory has children doing the hard things first. You study, practice and bear with it, and then you get the nice guitar. The other is instant gratification – buy the nice guitar to start to make learning the guitar enjoyable as soon as possible.

Mr. Powers advised against the delayed gratification approach because it could sabotage the child’s learning. “The least enjoyable part is the moment you first pick it up,” he said. “You’re physically struggling with an instrument that you don’t know much about.”

And for a child like mine who wants to play acoustic, he couldn’t help but wax eloquent on the virtues of the Baby Taylor’s function over form: its intonation, seasoning and repairability. I know a bit about music and caught his drift, but I wasn’t sure his arguments would pass muster with every parent.

I took his comments back to my friend Craig. He reminded me that most famous musicians did not learn to play on top-of-the-line equipment. And while the Baby Taylor is portable (which is why many adults love owning it too), he wondered whether we’d be inclined to tote it around given its price and the possibility of damaging it.

My wife asked another question that I hadn’t thought of: Why not buy our daughter the cheap guitar (or at least a decent but lower-priced used one), and spend more on a really great teacher or a larger number of initial lessons? It’s an excellent question, if only we knew which style of teaching would be best for her. Picking out an instrument seems easier somehow.

One of Craig’s most recent musical purchases for one of his sons was a used instrument. Indeed, buying someone else’s Baby Taylor would set us back only $200 to $250. Older ones seem to hold their value reasonably well, which means we could hock ours if my daughter doesn’t take to playing or graduates to a bigger guitar within a few years. Craig said he did not find this approach overly indulgent.

And to Mr. Powers at Taylor, who has made music his life’s work, the choice of instrument is one with the highest of stakes, as he’s not sure he would have stuck with it if he had been learning on a glorified toy. “The difference between that person who says ‘Oh yes, I took lessons when I was a kid’ and someone who engages forever is when they cross over from studying to doing an instrument,” he said.

I do want my daughter to play on a guitar that gives her the best chance of crossing that chasm. But my hunch is this: It wouldn’t have taken $329 to get me to “do guitar,” had anyone thought to suggest it when I quit classical piano lessons after 10 years.

And perhaps that’s one more reason I find the used Taylor — which we’re now in the process of hunting down, at $100 or so off the new price — so enticing. If my daughter doesn’t stick with guitar, I just may keep her instrument for myself.

Ron Lieber is the Your Money columnist for The New York Times and the author of “The Opposite of Spoiled,” about parenting, money and values.


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Clumsiness as a Diagnosis


Credit Anna Parini

Years ago, I took care of a little girl whose mother worried tremendously about her clumsiness. When she was 4 or 5, my patient was still tripping and falling more than other children her age, her mother thought. She had trouble with the clapping games in her preschool. The mother was visibly distressed when she talked about this. She told me that she herself had been “that kid,” the clumsy one, the last one chosen for every team.

For a long time, a variety of terms were used in medicine and education to describe children who struggled with coordination but had no underlying condition, terms like the ominous-sounding minimal brain dysfunction, the milder movement-skill problems, and yes, clumsy child syndrome. In 1994, these were consolidated under a single diagnosis, developmental coordination disorder, though this covers a wide range of children who may struggle with anything from handwriting to riding a bicycle.

There is always a risk when you apply a diagnosis, always a chance that it will be seen as “pathologizing” or stigmatizing children. Are kids better off thinking of themselves as just kind of awkward? Should parents shrug and say, “no one in our family is a good dancer”?

“I think there is a perception out there that children who are clumsy are just children who aren’t good at sports,” said Dr. John Cairney, a professor of family medicine at McMaster University in Hamilton, Ontario, which maintains a website about the disorder with useful advice for parents. It’s more important, he said, to think about “how it affects children and adults in everyday activities — tying shoelaces, using knives and forks.”

The need for a diagnosis depends on whether the child is actually struggling. Pediatricians and pediatric neurologists do sometimes encounter parents who worry because a child isn’t gifted at sports, or at a particular sport. Not being gifted, or even good, at sports is not a diagnosis, and it’s probably more important for that child’s well-being to help parents take a new look and find the child’s real strengths and inclinations.

“Some of these kids come in referred to me, and they really look pretty normal; a lot is parental anxiety,” said Dr. Stephen Nelson, a pediatric neurologist and an associate professor of pediatrics at Tulane University, who wrote the Medscape article on developmental coordination disorder. “It’s O.K. if he doesn’t throw the ball well; he can have other skills,” Dr. Nelson said. “We don’t all have to excel at everything.”

On the other hand, a child whose fine-motor skills are far behind what is age appropriate may struggle to put on clothing, or feel bad about activities that children do for fun, like playing with Legos. And there are children whose problems go beyond just being average (or a little worse) at basic athletic skills, and those children can find themselves dreading gym class, and in some cases even being bullied.

“You have parents and teachers attempting to push them into activities, believing the problem is motivational, not neurologic or motoric,” Dr. Cairney told me. “They get bullied, called stupid or klutzy.” With a diagnosis, he said, the children’s quality of life might improve, especially if they are given good advice about how to manage the problem.

Taking the clumsy child for evaluation is all about whether the child could use some help. That may involve modifying the child’s environment: Lots of children are referred for evaluation because of dysgraphia, or terrible handwriting. Learning how to use a keyboard can make a huge difference for their school functioning.

Occupational therapy is a mainstay for these children. They have to practice the specific skills they want to improve, whether that means handwriting, tying shoelaces or using a knife and fork.

An evaluation may help tease out problems that aren’t actually coordination issues. Some children look clumsy because they’re distracted, not paying attention to the motor — or athletic — task at hand. Others may have visual impairments. Doctors worry more if a child is delayed in several realms at once; if speech, fine-motor and gross-motor are all lagging. Most concerning of all is when a child who wasn’t originally clumsy starts to lose coordination skills, or begins to walk differently. Such a child should definitely be evaluated, because something new and medically serious could be going on.

So what about my patient? Well, she illustrates another point: Developmental coordination disorder is found more often among children with other issues, like attention problems, learning issues and autism. Parents with a child who is not doing well in school and also seems uncoordinated should take the lack of coordination as a reinforcing reason to have developmental and academic testing done.

That was true with my patient; her mother was very focused on her daughter’s clumsiness, but her preschool teachers were worried that something was getting in her way in the classroom. She ended up needing some special help with reading and schoolwork as she entered school. I would probably take her mother’s concern about clumsiness more seriously sooner these days, looking at it as a clue to that larger issue.

Clumsier children may become more self-conscious about displaying their motor skills and less likely to participate in games and activities, and this may mean they get less practice. And practice does help everyone, from the naturally gifted to the rest of us.

“In general, most of this gets better with time,” Dr. Nelson said. However, he added, it’s not something that children completely outgrow; clumsy children, on the whole, tend to become clumsy adults.

With more screen time and less freedom to play outside unsupervised, there’s also a concern that many children may have a lower chance of developing and practicing many motor skills (other than swiping and clicking). “We need to do more to support children’s global motor development,” Dr. Cairney said, “not to ensure they become athletes, but to ensure they can participate in a range of activities.”


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