Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Friday, August 19, 2011

Back to School, Maybe for the First Time

I recently participated in a very pleasant interview/discussion with a representative of the organization care.com. We talked about issues belonging to this time of year (August), especially “back to school” events. Because my interviewer has a four-month-old, we also discussed entry into day care. You can see a version of the discussion at http://www.care.com/child-care-back-to-school-troubles-p1017-98420002.html, but here are some other thoughts about these issues..

Not all children are concerned about staring back to school. Older kids may be bored with summer and ready for a change, especially if they are returning to a familiar school with familiar classmates. But younger ones may have some anxiety about the whole thing--- after three months of vacation they may not remember all the details they once knew well-- and are especially likely to feel worried if they are going to a new school, with a new teacher and new classmates.

Whether or not children express concern about starting school, it’s probably a good idea to make sure that their last week or two out of school is a calm, undemanding period. Unless there’s absolutely no choice, this is not the time to take an elaborate and fatiguing family vacation. Traveling with children is hard on the whole family, as we can see when everyone gets home and younger children demand even more attention than usual of their exhausted parents. Although a vacation trip may end with wonderful memories and a sense of family solidarity, it’s also a time of stress when new experiences demand extra consideration of each other’s needs if “meltdowns” (of parent or child!) are to be avoided.

Don’t forget that even a trip of a week in length really takes two weeks when you count planning, packing, unpacking, and catching up afterward, and those are two weeks when young children experience unpredictable events that are inconsistent with their usual lives. Yes, those are valuable experiences, and we want children to learn that things aren’t just the same all the time; however, it’s probably better for children not to have those experiences just when they are about to enter a new situation that will not become completely familiar to them for a couple of weeks.

Most children of school age are only a little anxious about school and adapt readily and quickly. Entry of younger children, toddlers, and infants into out-of-home child care is not such a simple matter, and how complicated it is depends on the child’s age and temperament. This matter is confusing to parents because it contradicts the usual rule that children get better at doing things as they get older. In the case of starting and attending child care happily, we see instead that babies under about 6 months of age are generally comfortable with non-parent care (always assuming that it is of good quality, of course), but that starting at some point in the second half of the first year, the great majority of babies will express distress at out-of-home care and will take some time to adapt to it. Preschoolers of 3 or more will probably show some reluctance to go into a new situation, but their developing language skills help them understand that a familiar caregiver will be back to get them, and that this will occur at a predictable time (“after juice” or “after circle time”, for instance).

This relationship between age and adaptability to child care does complicate life. Many parents are reluctant to use out-of-home care in the early months because of a realistic concern about infectious disease, or about the amount of attention a young baby needs, or about continuing to breastfeed. The parents may at that point also have access to continuing maternity leave that gives them the option of caring for their baby at home. Although the baby at this point may be able to adapt very easily to out-of-home care, there are many reasons not to use child care at that point.

A few months later, in the second half of the first year, parents may have weaned the baby from the breast, may feel he or she needs less individual attention, and perhaps have become more accustomed to common childhood illnesses. Maternity or paternity leave has probably run out in the U.S. (if indeed they had such a luxury). There are growing reasons for out-of-home care. But, whoops! The baby has developed to the point of feeling quite anxious about strange people and places. Adapting to care outside the home is a lot more difficult than it used to be.

What to do at this point? Are there ways the parents can ease their baby’s transition and make the family arrangements they need without excessive stress on anyone? Yes, most babies can be guided into greater comfort with a strange care situation, and the key word here is “gradualness.” Perhaps a few people have learned to swim by being thrown into water over their heads, but more have been frightened badly-- and the same thing is true of babies having new experiences. A gentle introduction fine-tuned by observation of the baby’s reactions is the best way to achieve a happy acceptance of any new situation.

Ideally, a baby should be introduced to a new care arrangement by short visits with a parent, leading after a few days to a short period there without the parent, and gradually increasing to the desired amount of care time. (A child care center that will not cooperate in this or that does not want the parent to stay is not a place you want to leave your child, by the way.) Ideally, also, the baby will have an assigned caregiver, and at least at the beginning will be cared for by that person most or all of the time, rather than having to deal with “floating” staff who work with any baby who seems to need attention. In addition, the ideal arrangement will involve careful attention to transitions, having a staff member greet the child and engage with her when she enters, and say goodbye as child and parent leave. Child care centers that are accredited by the National Association for the Education of Young Children are well aware of these points.

Real life is not ideal, of course. What if things just don’t, or can’t, work out this way? Let me give just one hint about what a parent can do: Don’t Sneak Out. Don’t ever sneak out. Tiptoeing away is easier on parents than hearing babies cry, but it’s very important for a baby to learn that a parent will not go away without making it clear that this is about to happen. Otherwise, anxiety may be constant that at any moment Mom or Dad could be gone, and when the baby feels this, it’s much harder to play and learn, or even to get used to day care.



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