• Knowledgebase: Parenting Questions

    Questions about the managment of common parenting problems such as discipline.

    4. You Can Lead a Child to a Highchair... but Will He Eat? - Top

    You Can Lead a Child to a Highchair... but Will He Eat?

    Pediatric News, May 2001
    BY E. KANDARIAN
    Contributing Writer


    CAMBRIDGE, MASS. — There are three things a parent can never make a child do—eat, sleep, or go to the bathroom, Dr. Marilyn Augustyn said at a meeting on behavioral pediatrics sponsored by Boston University.

    So what's the best way for a parent to approach these issues? There is no one best way—and there are many ways, said Dr. Augustyn, director of training at the division of developmental and behavioral pediatrics at Boston University.

    There is no shortage of written material on the subjects, she said. A basic Amazon.com search for the topics revealed more than 600 books.

    As to nutritional issues, 25%-35% of children experience feeding problems— ranging from the picky eater to vomiting, unusual food habits, and poor mealtime behavior. Only 1%-2% will have growth deficits as a result of such difficulties. Feeding problems should be considered when a child presents with poor weight gain, food refusal, or obesity, Dr. Augustyn said.

    Her reading recommendations on this topic include: "Coping with a Picky Eater: A Guide for the Perplexed Parent" (New York: Simon & Schuster Inc., 1998) by Dr. William G. Wilkoff; "Dr. Spock's Baby and Child Care" (New York: Pocket Books, 1998 ea.) by Dr. Benjamin Spock and Dr. Steven Parker; "First Foods" (New York: Dorling Kindersley Publishing Inc., 1998) by Miriam Stoppard; and "What Are We Feeding Our Kids?" (New York: Workman Publishing Inc., 1994) by Michael F. Jacobson and Bruce Maxwell.

    Children resist sleep for two basic reasons: It's boring, and they fear separation from their parents. The problem is a common one. In one study of 3-year-olds being treated for sleep problems, 84% had trouble sleeping since infancy. In general, sleep problems occur in 20%-30% of infants.

    Pediatricians who explain the number of hours of sleep required by children (see box) will help parents as they try to get their children to adopt regular sleeping habits.

    "I find it useful to pick out one or two common books to recommend to parents on any of the topics," she said. "But I advise you to read the whole book first."

    The philosophical spectrum of the sleep issue is represented in such books as "Solve Your Child's Sleep Problems," (New York: Simon & Schuster, 1986) by Richard Ferber; "The Fussy Baby: How to Bring Out the Best in Your High Need Child" (Franklin Park, Ill.: La Leche League International, 1985) by Dr. William Sears; and "On Becoming Babywise: Parenting Your Pretoddler From Five to Fifteen Months" (Sisters, Ore.: Multnomah Publishers Inc., 1995) by Gary Ezzo and Robert Buckman. The books run the gamut from Ferberizing, which involves responding to a crying infant at longer intervals without physical attention, to Dr. Sears' method of constant attention, to the Babywise approach, which stresses definite parent-guided feed/ wake / sleep routines at regular times.

    Dr. Augustyn's recommendation is the "best middle-ground, level-headed discussion of what's out there for parents": the American Academy of Pediatrics' "Guide to Your Child's Sleep" (New York: Villard Books, 1999). It compares the top five theories: sleep associations, the method of crying it out, the Ferber method of self-soothing with checking, scheduled awakenings, and the family bed.

    In terms of the toilet-training issue, Dr. Augustyn outlined a pair of approaches— one explored in Dr. T. Berry Brazelton's book, "Touchpoints: Your Child's Emotional and Behavioral Development" (Cambridge, Mass.: Perseus Publishing, 1998) and the other detailed in the controversial "Toilet Training in Less than a Day" (New York: Pocket Books, 1974) by Nathan H. Azrin and Richard M. Foxx.

    Dr. Brazelton's approach is starting with the child sitting fully clothed on the potty, then removing the diaper after a week or so and putting a dirty diaper in the potty, and always using gentle praise without any reproach. The Azrin-Foxx approach takes up an entire day and involves four rewards given for each success (verbal praise, hugs, something good to eat, and references to "friends who care"); this method does include expressing disapproval when there is an accident.

    Overall, Dr. Augustyn said, parents should not ignore their basic parenting instincts, which usually prove correct. And pediatricians would do well to advise parents of an axiom once offered by Dr. Spock: "Trust yourself. You know more than you think you do."
    - Updated: May 18, 2001

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    • James L Horwitz, MD

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