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Self-soothing so my child can self-soothe (Parenting Journey Part 3)

Our baby finally learned to self-soothe! In the first few months, as I sat with my baby asleep on my lap, rocking her for hours, trying not to move an inch or make a sound, while reading about putting your child down “sleepy but awake,” this milestone of self-soothing seemed completely out of reach. However, 3 months rolled around and our daughter suddenly and miraculously discovered her thumb. Despite some initial resistance to let our daughter suck her thumb, the encouragement of our pediatrician and the realization that this put her to sleep led to a pretty swift reversal on this judgment. Now, my husband and I will place our sleepy daughter on her back in her crib, walk back to the living room, and then watch in fascination as she eventually flops to her side, finds her thumb, and gets herself to sleep. The memories of me sitting and rocking her with one of my arms fast asleep and my phone, kindle, and remote control just out of reach, while I try to stifle every cough or sneeze and pray that our noisy neighbors do not walk by our door seem so distant now.

So how does this relate to my work and to the parents and children that I work with? I have been starting to think of this as the concept of “the art of getting out of my child’s way and letting her calm herself.” While my daughter will eventually make it to her side, find her thumb, and fall asleep, there are often numerous tries and cries and squeals that come first. My husband and I initially would come into the room right away and try to soothe her every time she started crying or just stared straight into the camera of the monitor (and into our souls, we would joke) “beckoning” us to come back. We have started to learn that every time we intervene, we actually are interfering with her process and it prolongs her ability to work on coping. We started to set a rule that we would wait 5 minutes before coming in and, 95% of the time, she is fast asleep by 5 minutes. A few times, I have built up the courage to wait 7 minutes and that seems to do the trick on those rare occasions it is needed. I realized that it really is mostly my husband and myself that are suffering during those 5 minutes that she is crying/squealing/staring blankly into the camera. If we can overcome our anxiety about her experiencing mild distress, our daughter actually has learned and can use the tools to calm herself and get the sleep she needs.

This really resonates with the concepts that I have learned and taught parents of children and adolescents with anxiety. A lot of times, the more we intervene with our anxious children, the less it gives them the opportunity to develop and practice coping mechanisms to challenge their anxiety. This does not have to be all or nothing, either. I mean, my husband and I are waiting only 5 minutes at the moment. This may mean just slightly delaying your response to intervene in anxiety-provoking situations for your child/adolescent. For example, if your child had social anxiety and difficulty ordering at a restaurant, maybe it is just taking a few breathes while the server waits for your child to respond instead of speaking for him/her right away. If your child is nervous about trying something new, maybe it is just asking them what they are nervous about and seeing if they have alternative ways of looking at the situation before providing them with reassurance or immediate solutions. You may start small and realize that your child may be able to manage their anxiety for a longer duration or more difficult situations than you once imagined.  I realize that my 4-month-old and her self-soothing capabilities are much simpler than the complexities of anxiety. However, sometimes it helps to start from the simple. I am starting to realize that my own anxiety about my child’s distress does not need to be transferred to her. She is resilient and letting her cry for a few minutes is OK and will help her continue to learn how to cope and to become more resilient. If parents want more resources for managing your child’s anxiety, I have read and recommend reading either of the following books. Both are based in Cognitive Behavioral Therapy (CBT) and align with this concept of helping your child approach, instead of avoid, anxiety-provoking triggers: Helping Your Anxious Child by Rapee and Anxiety Relief for Kids by Walker.

My Parenting Journey – Part 2 (The App Tracking Trap)

From all of my experiences as a child and adolescent psychiatrist, I knew how important it was to set reasonable expectations for myself and my future child. However, knowing, believing, and enacting do not always align! Early in this journey, I found myself getting stuck in the details caused by my baby tracking app. I had been given advice to find an app to track sleep, diapers, nursing, etc. This all made sense to me and seemed like a simple solution to help organizes are newly chaotic lives. While tracking this data has been helpful in some ways, I have found that it sometimes makes me lose perspective. For example, the app will chart out sleep patterns for the baby. I have spent an embarrassing amount of my day combing through the data to try to figure out the “exact right time” to put the baby down for a nap or for bedtime. I even have made a google sheet of data trying to find some “perfect” schedule that will get my baby the “right” amount of awake time, nap hours, and sleep time. I’m sure you notice I have put quotations around the words “perfect”, “exact”, and “right.” This is, of course, because I really truly don’t believe there is a perfect, right, or exact here. I completely have gotten stuck in the tiny details and caught in some perfection trap. Whenever I ask my pediatrician questions about the baby being “OK” or not, the answers are very simple. Is she gaining weight and having enough diapers? That’s it. She does not ask about awake windows, bedtimes, or nap times. Even without those numbers, I can look at her and see if she is calm or fussy, comfortable or in distress. Even though it has only been a few months, there is a true gut feeling and parent intuition that can guide me and tell me whether the baby is truly OK or not. Giving myself some moments of mindfulness, which usually occur during my daily walk, helps bring me back to a healthier perspective. On the other hand, sitting and staring at my phone and baby tracking data does quite the opposite.

So how does this relate to my patients and their parents? Life obviously gets quite a bit more complicated as your kids grow up. You need to focus on a few more details than just weight gain and poopy diapers 😊 However, I believe that our parental focus can still be more zoomed out and focused on the big picture than it often is. With my new perspective, I encourage parents to do two particular things. First of all, think of what are the basic things that are important to your child’s wellness? What are those few things you really need to keep track of to make sure your child is OK? You can start with general areas, like physical health, emotional health, and school. Then, consider some basic goals in each area. If your child is not meeting those goals, then start with a smaller goal and know you can always allow them to grow into your more aspirational goals. Next, give yourself daily moments of mindfulness (or, a time and place during which you can think uninterrupted at the minimum) to check in on those goals. I think of this as a daily reboot for my brain. While I may sit and try to draft up a nap and bedtime schedule like my child is an engineering problem set from my college days, when I go on my walks, I drop those details. I remember that she has been gaining weight like a champ (and her adorable baby rolls remind me that she probably continues to do so) and is also a diaper champ (not always my favorite achievement of hers, but still important). My added goal is that she seems generally happy. Judging from the endless smiles and coos we get all day, I can check that box as well. While I would love for her to be on a schedule so there is more predictability in our lives, that is still aspirational. I have not given up on it, but I surely can sleep better at night when I let myself remember each day that she is doing OK. So, parents, give yourselves that opportunity to remind yourself that your child is OK when they actually are doing OK. This way, if they truly are not, you will be able to recognize this more easily and respond to it more effectively.

Lessons learned from a child and adolescent psychiatrist and new mom (Part 1 of infinity 😊 )

For years, I have been aware that, despite all of my clinical training, I just never could really truly understand the experience of parents until I became one. So, while I provide evidence-based recommendations to parents, I was also looking forward to the day I could say “I understand how difficult this is” and really, truly understand it from my own experience. Well, just over 3 months into parenthood, I wanted to share some of the lessons I have learned from my own parenting journey. I will try to write them as I discover them and imagine this is an endless journey.

First of all, “parenting journey” was a very intentional use of language. My baby is changing every day. The tricks that worked yesterday for soothing her or getting her to sleep do not necessarily work today. It is not her fault and it is not my fault. She is not a “bad baby” and we are not “bad parents.” She is just growing and developing and we need to be aware of it and go along on the journey with her. There are many moments that I feel hopeless and helpless after trying to get my crying baby to sleep using the exact techniques that worked yesterday and that are only inciting her more! However, after getting some space from that moment (and a little nap for myself), I have been able to approach my parenting with more self-compassion and to remind myself that this is actually normal. It is only “bad” or “wrong” if I don’t pay attention to her cues and grow and change with her. Otherwise, she is going along her journey of development and I am just left behind.

How does this relate to my own clients and their parents? Parents, remember you are on a developmental journey with your children and adolescents. If some technique was effective with parenting your child in the past but it not anymore, maybe it is because your child is developing and you need to go back to brainstorm an updated solution. Often, it is not a completely new solution, just a tweaked version of the prior one. Brainstorm with your partner, if there is one. I have had to leave my ego at the door and accept that some days my husband found a better solution than me (even though he has had zero experience with children!) Some days I found a better solution and he follows my steps. Remember, no matter who solves the problem, everyone wins here if the updated solution is more effective! If you are parenting with a partner, remember that you are on the journey together and it is ok for one of you to find the next path that works. What is not effective is if you resist taking those steps because you did not find it or because it was not the prior path. So, parents, I am on this journey with you finally. It is hard and scary and I try to take moments and pat myself on the back when I find something that works, for the moment at least. When is feels like I am in the middle of a “failing technique,” I am just letting myself take slow, deep breaths and hoping that sense of calm and comfort transmits to my baby.

New Year, same goals

Several times a week, I will coach a parent, teen, or adult patient about how to use the principles of behaviorism to change his or her behavior or the behavior of someone else. This year, I finally have found some success applying it to myself! I have been wanting to get more active for a long time both to improve physical and mental wellness. I often have created goals for myself, even created a worksheet to fill out on my refrigerator with a reward system. However, change would last for a couple weeks at the most. By combining enough behavioral principles, I finally found some movement (literally and figuratively) . I had bought a pedometer months ago hoping tracking steps would motivate me..not so much. What does motivate me, though? Chai lattes! (positive reinforcer). I started by just monitoring how many steps I was getting on average per day. The answer was, quite low. Using the principles of shaping, I decided to set my first week goal to just a little higher than my usual average in order to start with some success. Knowing that some days I have too many patients and meetings to meet my goal, I allowed myself one day to miss my goal. At the end of the week, if I met my goal 6 out of 7 days per week, I get a new Peets card to use.  It has been about 4 weeks and I have been able to increase my weekly goal by 2,000 steps, have felt more energetic, have been sleeping better, and actually lost a little bit of weight. In essence, I finally practiced what I preached. Some of the key points here are first to monitor where you are at. It would have been too much to expect 10,000 steps per day when I sometimes barely made it to 2,000. Next, think of a reward that will actually reinforce you to change your behavior and make sure to implement the reward. Even better, I sometimes will get half of my steps in by walking to Peets to use my reward! It is helpful to give yourself “partial credit” so that if you cannot do the behavior every day you still get some sort of reward (ie. 6 out of 7 days per week). Once you master one step, keep moving toward your final goal (ie. shaping). That is why I am now 2,000 steps higher and plan to increase my goal by 1,000 steps next week.  A final help can be the accountability factor. My partner and I both set steps goals and update each other daily. He also holds the Peets cards so I cannot reward myself if I do not meet my goal and I get the pleasure of asking for my reward at the end of the week!

This article is helpful on discussing how to shape someone else’s behavior: http://www.nytimes.com/2006/06/25/fashion/what-shamu-taught-me-about-a-happy-marriage.html. You can also read a book that was recommended in my dialectical behavioral therapy (DBT) training called Don’t Shoot the Dog: The New Art of Teaching and Training.  So, next time you are hesitant to set a new goal for yourself, just remember, just because you did not have success before does not mean you will not have success in the future. You may have asked for too big of a change right away or may not have picked enough reinforcers for yourself to change the behavior. I still am not sure how I feel about the fact that humans can train ourselves and others just like we can train animals, but I’m not thinking about it too much as I sip on my delicious Chai Latte!

Driven to be mindful

Yesterday I went to an alumni drop-in session for the Compassion Cultivation Training (CCT) course I took last year.  During the session, the moderator asked participants to journal about various ways we have used mindfulness this past year and goals for the next year. Upon reflection, I was glad to see that I have taken several steps toward more fully integrating mindfulness into my life.  I have begun to put my phone away  much more often. Out of sight is not quite out of mind,  but it is much easier to prevent myself from getting distracted with the future or the past and to stay in the present moment. I also have attended a few sitting meditation events locally.  I realized how much I have been craving to start a daily meditation practice and have set the intention to begin doing so in the coming year.  When we shared with the larger group, one of my peers mentioned that she sets an intention every morning about her day.  I loved this idea and already have set my morning alarm to remind me to set a mindful intention.

Interestingly, as I sat and listened to how others have been integrating mindfulness, I came to the realization that I actually have been utilizing mindfulness and compassion regularly while driving since taking the class. During my CCT class, we spoke quite a bit about the usefulness of using mindfulness while driving. For example, my teacher noted that once she realized that getting upset and stressed while stuck in a traffic jam did not get her to the destination faster and only led to suffering in herself. I realize that I now start to notice when I am getting upset about running late and much more often remind myself that I will get to the destination at the same time and I do have control over my emotional state when I arrive. This is when I will take a few deep breaths to lower my heart rate. We also spoke about how angry we would get at drivers who would cut us off or drive unsafely. We discussed how we could choose to get angry and irritated with these drivers or we could practice compassion toward others. We could realize that sometimes we are that driver and we often have very justifiable (or we justify to ourselves) reasons for our actions. Instead of reacting with a negative response, we can instead react with curiosity. I realize that I often will make a neutral comment in response to these drivers. “That car is driving fast” in a neutral tone affects me much less than thinking “what a jerk!” Instead of arriving to my destinations angry and frazzled, I have been able to drive much more calmly, and I imagine, also safely. I wanted to share this realization with others to help give you some examples of how to integrate mindfulness into your daily lives and also to keep myself accountable to continue working on these skills. Mindfulness is like a muscle. It improves the more we practice. That is while I encourage you all to be driven to drive more mindfully!