12 September 2005
Dear Readers: Sincerely,
Dr. Warren hopes to help all who ask his advice and to enlighten all who read Ask Dr. Warren. For your own well being please keep in mind that
advice you read here may not apply exactly to your own situation, and that if you are sick, no information on the web can take the place of a hands on examination by your physican who knows you and cares about you.
Dr. Warren
Well, to my question. Because of my son being to me, as a single mother, sick all the time when he was younger and being an only child I have taught him well how to be "spoiled" and get whatever he wants with nothing in return. Lately, me and my fiance, who my son loves dearly, have been giving my son chores, such as cleaning his bedroom or wiping off the glass to table to earn an allowance of $20 every week. My son is having a really hard time adjusting to responsibility the last few months and does everything he can to get out of these responsibilities and to receive whatever he wants anyway. I am trying real hard to be firm with him and teach him responsibility with these chores, but it is becoming really hard. Most of the time he refuses to clean his room and it gets trashed. He is constantly telling me "no he don't have to", "I am not his boss", and more or less to make him. This behavior can really stress me out at times. No I do not always discipline him for this behavior or for his actions. I am afraid that this discipline, going to his room, that upsets him so much, will affect his future. I know that sounds crazy, but I'm just trying to make him happy. I enjoy giving him everything he wants, but have been told that he needs to learn responsibility by doing these chores. What is your advice? Should I begin being more firm when it comes to his chores? Take his allowance away when he does not do these chores? Make him do these chores if he likes to or not? Ignore his rude comments or discipline him for them? I just want my son to have all out of life. He plays sports and is very active but will not cooperate with me when it comes to too much. He does not understand why "grown-ups are the boss". Help!!!! Iam going crazy!!!! Why do eight year old boys think they are the boss?
-K
Dear K: My first thought was, "Why does an 8 year old need a $20 allowance?" It may be appropriate if he is learning to manage money and is responsible for certain usual childhood expenses, but that's not what you asked me about.
I'd like you to read two articles I've written, Managing the Difficult Child: School Age Children and Managing the Difficult Child: The Child Who Refuses to Cooperate. After you read these articles you'll want to think about some issues that are unique to your situation.
Keep in mind that your son was used to doing things a certain way. Now, suddenly, you want to make some changes. It's never too late to try to change for the better, but from your son's point of view things were fine the way they were before. Why should he change? And what changes will turn his world upside-down next?
You may be getting into conflict with your son due to unrealistic expectations and the fact that you're using the wrong motivation to get your son's cooperation. Nothing will ever make cleaning a room fun, although, with a little ingenuity, you can make games of some parts of it, such as a race to see how fast certain items can be put away. That kind of game; however, is only good for small parts of a chore, since it won't maintain a child's interest for hours. It only works when there's a quick payoff.
If your son doesn't have experience cleaning his room, it is unrealistic to send him to do the job. Many children require ongoing supervision to learn to do such a chore. Of course, it would take less time to do it yourself than to teach your son how to do it, but if you don't think the chore is worth your time to teach it, why should he feel it's worth his time to do it. If you keep him company and break the job into manageable tasks for him, he will learn to organize the work so he can get it done. If you share the work with him, it shows him that you value the task at hand while helping him to learn to do the job so it pleases you. It also allows him to see that he is helping you to accomplish a task, and not just doing something because you said so.
Withholding allowance may be an appropriate punishment for not fulfilling ones responsibilities, but that threat is not an appropriate motivation to do a job. Your son can too easily decide he doesn't need or want his allowance. If he has a big enough bankroll he won't even feel it, and I'm sure he won't end up missing anything important for lack of funds. The motivation for doing any job has to be a sense of accomplishment from doing the job and a feeling that the job has value. Children need to learn that their chores are not just busy work. When you help your son to learn to do a job, you also need to reinforce your satisfaction with each part of the work he does. Even when he knows what steps need to be done to accomplish the whole job himself, you should be prepared to inspect each step and praise his efforts.
When it comes to discipline, be consistent. Try not to make everything a disciplinary issue, but don't discipline him for something one time and ignore it another time. He doesn't have to understand why grownups are the boss. Don't be disarmed by your inability to give him a satisfactory answer for that, because no answer you give him would satisfy him. If he thinks kids should be the boss ask him if he'd like to have a 6 year old in charge and how he would like it if when he was hungry and wanted dinner you started whining "I don't feel like cooking."
You can't make a spoiled kid happy because no matter how much you give him, there's always something he wants that you can't provide or is inappropriate. There are lots of ways you can make him happy, but you have to have the strength of your convictions to provide guidance when it's appropriate and discipline when it's appropriate. Your son won't always be happy with what's right or best for him. As an adult, you have to be able to see beyond that moment to the happiness that comes from getting along with others and being a productive member of society.
Sincerely,
Dr. Warren
-Diana
Dear Diana: With regard to your main concerns, formula is complete food and can meet your son's nutritional needs indefinitely should that be necessary. Developing good eating habits later on in infants who refuse solids can be difficult, but there is no reason any other aspect of your son's development should suffer from anything you have described.
I have too little information to make any sound medical judgments about your child. I don't know what his growth has been like or what his neuromuscular, language, or social development have been like to date. I also don't have the benefit of having examined your son or having all the test results your doctors have, but I'll step out on a limb here, realizing I could be way off base if there's something I'm missing.
Unless your son has some pain when he puts food in his mouth, it makes no sense for him to refuse food if he's hungry. On the other hand, he may have developed an excessive attachment to his bottles which is interfering with his eating. At 10 months your son is just the right age to experience separation anxiety. If he uses bottles to put himself to sleep, then his nighttime waking is probably trained night feeding, a pattern of demanding bottles for comfort during the night rather than due to hunger. If your son drinks bottles all day and night, he's not going to eat food. Unless your doctor feels that your son's condition requires continued feeding during the night, the first thing you have to do to change the situation is get your son back to sleep during the night without giving him bottles.
If your baby is anxious to eat your food, at 10 months you can start introducing table food. Just go slowly since he appears to be an allergic child. Getting him to enjoy and live on solids does not have to be accomplished quickly.
Sincerely,
Dr. Warren
Why?
-Mr. & Mrs. V
Dear Mr. & Mrs. V: My personal opinion is that today's disposable diapers with the absorbent gels do a better job of keeping babies dry than cloth diapers; however, it is always possible that a baby may be sensitive to something in the disposable diaper and develop a rash from that.
Sincerely,
Dr. Warren
Would they be looking into the hypothalmus? He has lost four ounces in the past week. He is alert, not lethargic, seemingly happy. No dehydration or signs of weakness in any of his limbs. No pain apparent. Please help me. My Sweet Babies are in North Carolina and I live in Florida. I want to help them in any way I can. I have access to all the Medical Libraries here in South Florida and also the internet. I hope to hear from you soon.
Thank you
-Grandma
Dear Grandma: I don't have enough information to know why the doctor thought an MRI of the brain was warranted. Anything which causes increased intracranial pressure including a brain tumor may cause headache and vomiting. The doctor could be looking for a brain tumor because of the vomiting, but I don't know if or why he would suspect one.
My prayers are with you for your sweet babies.
Sincerely,
Dr. Warren
I have white solid substances which come out of pockets, or cavities (holes), in my tonsils. Someone once guessed that it may be food, but if that where the case it seems the coloring would change according to the food substance (ie. bread, meet, veg.). Also, this "solid" has a very foul odor.
Have you ever heard of this or seen anything like it.
-James
Dear James: You are describing enlarged tonsillar follicles. The tonsil is lymphoid tissue which reacts to inflammation and infection. An activated follicle may enlarge and then slough off resulting in a whitish to yellowish piece of crud the consistency of a spit ball. If these are recurrent, it may suggest a chronic low grade infection which should be checked by your doctor. Unfortunately, if the original infection which stimulated the tonsil was viral, it won't benefit from antibiotic treatment.
Sincerely,
Dr. Warren
His mother is nursing him and she is taking an herbal concoction to loose weight. I have tried to impress on her that as long as she nurses she should not expose the baby to it. But her answer was I took it the whole time I was carrying him, he should be used to it.
I am so concerned. I would appreciate your advice. Thank you.
-CF
Dear Grandma F: There is no cure for colic and indeed most infants outgrow it by 4 months of age. The issues in dealing with colicky infants include looking for possible causes of the infant's crying, providing approaches for dealing with the crying, and giving the parents reassurance and support through the difficulty. Most colicky infants will have multiple formula changes before they outgrow it or improve due to the formula change. Nursing mothers may need to eliminate things from their diets until they find something that makes a difference.
I don't know anything about the herbal concoction the baby's mother is taking, but I have no basis for concluding it is harmful. It appears that the parents have brought the baby to a pediatrician and addressed the problem and they are satisfied with his answer. Therefore, it is not likely the parents would appreciate any unsolicited advice from me.
Sincerely,
Dr. Warren
-Alison
Dear Alison: The child you're describing may have cerebral palsy; however, her dysmorphic features (small head with prominent forehead) suggest a more complex diagnosis. Cerebral palsy is a specific type of neuromuscular condition in which spasticity, ataxia, or spasticity may be the predominant feature. Intelligence may range from retarded to superior since a variety of neurological injuries can cause cerebral palsy. Seizures may also be part of the picture depending on the neurological damage.
While I cannot say that the child in question has cerebral palsy, it is clear that she has significant developmental delays and neurological deficits regardless of the results of any imaging studies. She should have a thorough evaluation by a pediatric neurologist and intervention by a multidisciplinary team of speech therapy, occupational therapy, and physical therapy.
Sincerely,
Dr. Warren
-Pat
Dear Pat: The two main possibilities that come to mind are that you could be experiencing a form of sleep disturbance [parasomnia] or a seizure. You should consult a neurologist and perhaps be referred to a sleep study center.
Sincerely,
Dr. Warren
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