GREAT PARENTS GREAT KIDS ROBY MARCOU MD DEVELOPMENTAL

GREAT PARENTS GREAT KIDS ROBY MARCOU MD DEVELOPMENTAL AND BEHAVIORAL PEDIATRICIAN BEACON SCHOOL FEBRUARY 2013 PARENTING A DEVELOPING BRAIN

PARENTING IS CHALLENGING SOMETIMES INSTRUCTIONS ARE CLEAR.

SOMETIMES THEY ARE NOT EVEN IF THEY SEEM TO BE! EVERYONE HAS WRITTEN A BOOK WELL MEANING PEOPLE ARE STILL CONFUSED THERE IS AN INDUSTRY OF CHILD PERFECTION, OF BEING A ‘PPC’

WAS IT ALWAYS THIS HARD?

MOTHER IN LAW WISDOM “the ‘C’ student will hire the ‘A’ student” “It was easy as a teacher to see which students were going to be successful people professionally. Given a certain level of intelligence and learning, it was the whole package that counted. . . empathy, social awareness, looks(undeniably true), sense of humor and play. . . ”

WHAT ELSE FRAMES OUR EXPECTATIONS DEMOGRAPHICS? FEAR OF FAILURE? NARROW DEFINITIONS OF SUCCESS? SEARCH FOR A DIAGNOSIS OR A LABEL? OUR IMAGINATION? SEEING OUR CHILD ACCURATELY GOAL OF RESILIENCE: APPRECIATING THE MUNDANE LIFE WITH OUR CHILDREN UNDERSTANDING THE DEVELOPING BRAIN

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NEURONS MAKE IT HAPPEN 8

WE NEED TO USE THE NEURONS- TO MAKE THE SYNAPSES. . 9

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HOW AND WHAT SHOULD BABIES THROUGH AGE 4 LEARN EMOTIONAL REGULATION LANGUAGE INCIDENTAL LEARNING SOCIAL INTERACTION PHYSICAL AND MULTISENSORY EXPERIENCES

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NOURISHMENT: FOOD ABCDEKABCDE KABCDEK 36 36363 636 FEFEFEFEFEF EFEEEEEF 15

NUTRITIONAL SUPPLEMENTS AND LEARNING Omega Fatty Acids Vitamin D Iron 16

OMEGA FATTY ACIDS • Omega 3 must be balanced with intake of omega-6 fatty acids as they have reciprocal functions related to inflammation responses, in particular. • Fatty acid deficiency can impact growth of myelin and thus impact development. • No established dosage in children. 17

VITAMINS LARGE BODIES OF EVIDENCE SUPPORT THE PREVENTIVE BENEFIT OF EATING FOODS RICH IN DIVERSE NATURAL FORMS OF VITAMINS THIS CAN BE CONTRASTED WITH THE KNOWLEDGE ABOUT SUPPLEMENTATION WITH A SINGLE SYNTHETIC FORM OF A VITAMIN 18

VITAMIN D Shortages cause rickets in children, osteoporosis in adults Maternal shortages during pregnancy are associated with lower language levels in children. Autism increase temporally associated with awareness of sun safety. Historic RDAS are low. Higher recommended dosages prevail. 19

VITAMIN D More accurately a hormone: our bodies produce it when we expose our skin to sun. 5 -15 min/day of summer sun. Brain cells also have the protein needed to convert to final active form- have receptors for Vitamin D. 20

WHAT ABOUT IRON? How much of a problem is it? • Up to 15 % of American children ages 3 -4 are iron deficient • Up to 5 % of children ages 3 -4 have iron deficiency anemia • Specific blood work needed for firm diagnosis • Increased in certain populations What are the impacts of an iron deficiency? 67% of those with anemia at age 3 show psychomotor delays; 21% of those with iron deficiencies* Long term effects- children with anemia in infancy and early childhood continue to show delays at age 10 years in spite of treatment 21

IRON SUPPLEMENTATION FOODS RICH IN IRON • Liver, beef, pork, lamb • Oysters, clams, tuna, salmon, and shrimp • Beans and lentils • Iron fortified whole grains, Greens and tofu • Broccoli, asparagus, Brussels sprouts • Chicken and turkey • Nuts, egg yolks, raisins, prunes, dates and apricots 22

Risk factors for iron deficiency include toddlers and older children who drink more than 24 ounces of milk each day Vitamin C can help your body absorb iron, so it is a good idea to pair iron-rich foods with foods that have a lot of vitamin C It is harder for the body to absorb the nonheme iron that is found in fruits, vegetables, and grains, than the heme iron that is found in animal foods IRON 23

NOURISHMENT: FUN Weeeeeeee Yahoooooo. We eeeeeeeee Oleeeeeee 24

PLAY object locomotor social 25

PLAY IS FUN. . AND MORE We are hardwired to enjoy activities that are adaptive. FUN is encoded in our brain such that it generates REWARD- in the form of DOPAMINE. Reward leads to neural plasticity- we learn. We want more! 26

PLAY AND STRESS? ! Severe restriction in play and movement is associated with elevated levels of the stress hormone, cortisol. Play increases dopamine and other hormones which facilitate learning, but not the hormones which are associated with increased stress. 27

PLAY AS PRACTICE FOR LEARNING AND FOR COMMUNITY LIFE Play generates the signals that enhance learning without an accompanying stress response. Thus, it allows practice for real life. Cultures that emphasize the development of independence place more importance on object play, interdependent cultures encourage social play 28

WHEN SIBLINGS PLAY! The best predictor of good sibling relationships in later life is how much fun children have together when they are young. . Conflict can be high, so long as there is plenty of fun! 29

PLAY BECOMES PASSION Learning what you like and Work in adult life is don’t like! often most enjoyable when it shares this Flow happens when we are doing active experiences that quality with play… require concentration but are very practiced- goals and boundaries are cleared, we have a chance to be creative. Immersion> solving challenges. 30

REST ZZZZZZZZZZ ZZZZZZZZZZ ZZZZZZZZZZ ZZZZZZZZZZ 31

PEDIATRICS VOL. 123 NO. 6 JUNE 2009, Adolescents Living the 24/7 Lifestyle: Effects of Caffeine and Technology on Sleep Duration and Daytime Functioning Sleep was significantly related to multitasking. Teenagers getting 8 to 10 hours of sleep on school nights tended to have 1. 5 - to 2 -fold lower multitasking indices compared with those getting less sleep. Thirtythree percent of the teenagers reported falling asleep during school. Caffeine consumption tended to be 76% higher by those who fell asleep. Multitasking was significantly related to falling asleep during school and with difficulties falling asleep on weeknights. 32

SLEEP sleepy at the wrong time of day (e. g. , after waking in the morning) trouble paying attention during the day tend to fall asleep very quickly when given the chance are “wired” at the wrong time of day child is easily frustrated and quickly irritated (Dement a n d V a u g h a n : S T A N F O R D 1. 5 -3 years: 1214 hours 3 -5 years: 11 -13 hours 5 -12 years: 1011 hours Teens: 8. 5 -9. 5 hours 33

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SLEEP MEMORY LEARNING REM SLEEP IS ASSOCIATED WITH PROCEDURAL MEMORY CONSOLIDATION SPECIFIC VULNERABILITY OF THE PREFRONTAL CORTEX TO INADEQUATE SLEEP (October 2006) SLEEP MEDICINE REVIEW Sleep loss, learning capacity and academic performance Giuseppe Curcioa, Michele Ferraraab, Luigi De Gennaroa 35

TECHNOLOGY MACPCXBO XPSDSWIIT VIPADIPODI TOUCHIAMI AM 36

SOME THOUGHTS ON DIGITAL LIFE AND CHILDREN Dr. Michael Rich: Center of Media and Child Health Harvard Medical School: § “Their brains are rewarded not for staying on task but for jumping to the next thing. The worry is we’re raising a generation of kids in front of screens whose brains are going to be wired differently” § What would the child be doing otherwise? 37

ENTERTAINMENT MEDIA Violence: § Exposure to violent media in childhood should be of concern, but should not overshadow concern over other sources of aggressive behavior Addiction: § 2+% addiction rate to internet, with 10 -20% of youth showing at risk internet use (studies are 3 -5 years old) § Pathways not clear 38

ENTERTAINMENT MEDIA Distraction: § Ophir- Stanford Uni Students- concurrent usage of several types of media associated with decreased ability to filter out distractions, greater distractibility by irrelevant information a in memory, less efficient task switching § Other studies related to attention, visual memory, as attention TV exposure in less than 3 year olds 39

GOOD SENSE: ALL THINGS IN MODERATION CONSIDER THE IMPORTANCE OF AN EVIDENCE BASE IF IT SOUNDS TOO GOOD TO BE TRUE IT IS 40

YOUR CHILD IS PHYSIOLOGICALLY READY… SO, NOW WHAT?

A FEW MYTHS. . self esteem breeds success means Harvard or MIT well rounded is better Lake Wobegon. . or everyone is gifted; everyone has ADD § the true nature of development § problems can be fixed; otherwise there must be an adjustment in expectations § a diagnosis does not equate with a cure, limitations might exist

SEEING YOUR CHILD ACCURATELY not everyone will see your child as you do, not every teacher will see your child in the same way report cards are a cross between romance novels and legal documents every child is unique and every child is ordinary

LOVING THE CHILD IN FRONT OF YOU no one is intentionally bad at their own development if you spend more than 20 minutes per day “worrying”, you will miss out on the fun children have built in ambivalence detectors loving the child, not their achievements

HONOR THE BASIC NATURE OF YOUR CHILD children just hatch the unlabeled packet of seeds § you can’t decide what you will get, or when it will bloom § be open, provide nutrients and a healthful environment. . . pull the weeds! understand accept the temperament of your child when it turns out to be London, not Paris

APPRECIATE THE DIFFERENCES BETWEEN BOYS AND GIRLS as young children> boys have shorter attention span and are less inclined to want to please as teens> girl are burdened by the desire and pressure to do it all

LEVERAGE YOUR CHILD TO THEIR STRENGTHS remember, as adults we only do what we are good at! figure out what the strength is- time spent on “remediation” takes time from this value who the child is, what they want help them become more interesting and interested success breeds self esteem the importance of becoming an expert

IS THERE ANYTHING ‘WRONG’ WITH JACK 115 IQ All academic skills in the range predicted by grade and IQ Has friends, likes video games and Big Bang Theory Hates Sundays No true passions Very inconsistent academic productivity Won’t try new things Negotiates everything Wants his mother nearby when he falls asleep

WHAT HAPPENS WHEN THE PUSHES BACK. . . at the loss of chance to enhance true areas of potential at the feeling that all the work is only for parental satisfaction-stress at the lack of interest which produces lack of mastery--stress at the parent- open rebellion--stress at themselves- somatic complaints--stress

WHAT ARE WE AFRAID OF An uncertain future ordinariness wanting/needing the Potential realized when the child to exceed the environmental provisions are parent adequate- when life is usually ordinary, occasionally § limited by our own imagination of what the extraordinary, expectations are realistic future will bring § skills- who knows what § enjoy the moments, the “low quality” time they will need is “specialness” good for self § traits- honesty, esteem? tenacity, flexibility, optimism, compassion § up on a pedestal it is hard to figure out what level you would/could reach

THE DILEMMA OF PUSHING- PAMPERING § the family becomes child centered- the whims of the child are catered to, while simultaneously the child is pushed § the achievements of the children are seen as a “family product”

“LE MIEUX EST L’ENNEMI DU BIEN” good enough is better than striving for an illusory perfection being an ordinary, devoted parent being a good enough kid children loved for who they are, not what they do, continue to strive a pass fail approach in a 4. 0 world

RAISING HARDY CHILDREN an alternative to pressuring children: preparing a child to find their own path if we protect against all pain and problems § helicopter parents § give the message they don’t have what it takes § fail to show that actions have consequences § enslave with our fears § inevitably, they will feel helpless

THE VALUE OF MAKING A MISTAKE mistakes are part of being human mistakes are how we learn we can learn to make, recognize and correct our mistakes- we need practice identifying and solving your own problems life isn’t a process of continuous encouragement kids need to see adults making mistakes and coping with them kids need to make “cheap” mistakes

INOCULATE WITH OPTIMISM bumps in the road are welcome chances show the child your faith they can handle give chances to make small, if reckless choices teach to withstand the consequences>> mature and self reliant tolerance for the inevitable appreciate that life is sometimes messy and unfair work to learn to manage emotional waves § specific versus general thinking

SO WHERE SHOULD YOU BE? ½ step behind when things are going well § informed if they are not § never ahead of the child>> you begin to look like the enemy model what you want to see- don’t tell it, show it! helping to set high goals with realistic short term achievables infusing tenacity: some are born with it, some need to learn they can develop it have the courage not to pamper

WHAT KIDS NEED BY THE TIME THEY GRADUATE HIGH SCHOOL. . the ability to ask a good question a passion and sense of competence meaningful relationship with mentors sense of saliency self discovery- to challenge their beliefs, ideas and abilities chances to self assess chance to feel meaningful, to give back rituals to frame transitions and to make life work

GIVING SPACE, PROVIDING LIMITS large enough framework so they feel supported and looked after § limits on TV, computer, video § limits on teens experience of space appropriate to age to: § try things that are new § make mistakes § be themselves § be silly/fun/juvenile/self express § allow for independence § pace themselves- hurried children

FINAL THOUGHTS: learning from our cultures, other cultures and respecting ourselves humans are the only mammals who parent with the goal of making offspring happy, in the rest of the animal kingdom the goal is fostering competence love the child in front of you.