Your Environment Matters

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This month I am pleased to be attending a conference of the International Society for Environmentally-Acquired Illness in Arizona.  The conference will build on my knowledge of chronic illness from mold, water-damaged buildings, lyme disease, and tic-borne illnesses.  As one of seven Canadians, and the only Occupational Therapist in the Society I am aware of how little information is available in Canada on environmental illness, and how difficult it is to find practical support and accurate information on environmentally-acquired illness.  I am eager to develop resources to support families who are concerned about indoor air, and environmental health.

As an OT working with families and young children, I understand the impact that our environment can have on infant and child development, and am enthusiastic about supporting families to improve their environments to support health and wellness.

Environment encompasses an important part of my assessment and work with families, and this conference will build on this knowledge set in order to better support families who suspect that environment is one component of the challenges that they are experiencing.

With Earth Day having just been celebrated this week, and with our attention turning to ways we can reduce our impact through environmental action, I cannot think of a better time to put environmental health and environmental illness front of mind.

Neufeld’s Six Stages of Attachment and What They Mean for Bedtime (Part I: Stages 1 to 3)

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My favourite Canadian developmental psychologist, Gordon Neufeld, outlined six stages of attachment to explain the development of attachment in children. I have found these stages helpful as a mom in knowing what emotional and attachment needs my boys could be expected to have, and how that can shape my parenting. Knowing the stages has allowed me to anticipate their needs better over the years, and has helped me understand their behaviour better too, something that any parent of a toddler will tell you is a bit of a miracle!

The stages that Gordon Neufeld describes are:

  1. Proximity

  2. Sameness

  3. Belonging or Loyalty

  4. Significance

  5. Love

  6. Being Known

As I watched my first two boys move from stage to stage, almost exactly as Neufeld described, I was awestruck with the idea that something as seemingly “soft” as attachment could be so predictable. I was also well aware that the attachment I was seeing emerge from them would form the basis of every healthy relationship they have in their lives. My third kiddo, somewhat obscured by the busy-ness of life with three boys, has benefited greatly from my understanding of the natural progression of attachment, while at the same time I have paid far less attention to the details. Despite my lack of attention, the stages of attachment have marched on anyway. I can say, though, that anticipating each stage, and reveling in this natural emergence of attachment, is really rewarding.

Here, I outline the first three of Neufeld’s six stages of attachment and describe what each stage may look like, and how parents can respond to the needs of their child at each stage.

In general, the six stages of attachment correspond to age in years. Developmental and neurological challenges, trauma, illness, and separation can all have an impact on the timing of these stages —and when this is the case, understanding these stages can be helpful for establishing attachment on a child’s own timeline. It is useful to appreciate that the stages of attachment are worth working through gradually, at a child’s pace, and with the intent to ensure the needs at each stage are fully met. It is also helpful to appreciate that we can be grown adults and still have needs that correspond to earlier stages of attachment, particularly if we have had negative relationships early on in our lives, or have experienced trauma and adverse childhood events. Babies don’t entirely abandon earlier needs (e.g. the need to be close), However, Neufeld feels that the better a child’s attachment needs are met, the more easily they will be able to move to the next stage of attachment. It is never too late.

It is also helpful to understand that attachment is “in the present moment”. Attachment can be temporarily ‘broken’ if we are distracted, angry, or disconnected, or if our children are frustrated, overwhelmed, or angry. And attachment that has fallen apart earlier in the day can be re-established through connection, empathy, and attention. By focusing on re-establishing our connection with our children “in the moment”, we can re-establish the bonds of attachment. In practical terms, this means bedtime can be wonderful one evening and then feel like it is falling apart at the seams on another: look at ways to reconnect at your child’s level, if things feel disconnected. It also means that bedtime can be a wonderful time of day to repair attachment: focus on slowing down, listening, paying attention, and reconnecting during the bedtime routine to finish the day with strong, secure attachment.

STAGES OF ATTACHMENT

  1. Proximity (1 year old)

What it is:

  • The need to be close, to touch you, to be touched by you, to be nearby, to see you, to hear you, to smell you.

What it looks like:

  • Babies will curl into you, reach out to you, cry when separated from you, be soothed by skin on skin contact with you, and have an easier time regulating with touch, breastfeeding, being held, or being carried.

How parents can meet this need:

  • Expecting babies to need to be close to you can help set reasonable expectations in the first year and beyond. Ways to meet this need for proximity include babywearing, roomsharing, holding, rocking, breastfeeding, bedsharing, and orienting yourself to hold baby for bottle feeding in ways that mirror breastfeeding (skin on skin, frequent cradling, considering having one primary ‘feeding person’ for bottle feeds) can all meet this need. Hugs, and squeezes, horseplay and cuddling are all very physical ways to meet this need. Using your soothing voice, your eye contact, or even remaining visible are all ways that help babies relax through your proximity.

  • As babies become more mobile, they will begin to move away from you but will circle back to you for proximity in order to get reassurance, particularly when unsure in a new situation. As they get older, this ‘circling back to you become visual: they will turn to check that you are still there.

  • By ensuring the need for proximity is met, we are reassuring our babies that we love them and are taking care of them.

2. Sameness (age 2)

What it is:

  • Two year olds tend to want to be like the people they love.

What it looks like:

Your child will mimic or imitate the behaviours, actions, and words of you and other very key caregivers (usually one or two key adults). Two year olds love to imitate household activities, facial expressions, gestures, and mannerisms. Children will often show an intense need for sameness of one caregiver over another at certain points in time. This may be difficult for the other parent or caregiver who can feel rejected and not understand why: the intensity of attachment is so great that it is often directed really strongly to one parent. This changes over time, and requires patience and understanding that it is typical.

What parents can do to support this stage:

  • Take pleasure in this imitation. Be playful with it. Model calm self-regulation, and share in these imitated activities as much as you are comfortable with. Enjoy this shared behaviour, and know that this imitation indicates a strong attachment to you. Encourage your two year old to help you around the house: wiping windows, folding cloths, using utensils, putting toys away. Imitation is a powerful indicator of attachment, but it is also nature’s way of setting the stage for behaviours that we come to expect our children to have. Know that if you are a loving parent who is not the object of this imitation, your presence, consistency, and love will lead to this happening: it is worth the wait!

  • At bedtime, create some ‘sameness’ with same physical belongings like pillow cases or even two stuffies that are the same (one for you and one for your two year old!) if you sleep apart. Same pajamas can also be a fun way to build on this stage.

  • The same routine, and reveling in that routine, can be a powerful way of providing security and predictability for your two year old. The same book, the same chair, and the same tuck in routine each night lets your child know what to expect.

3. Belonging/Loyalty (age 3)

What it is:

  • A strong sense of acceptance as a family unit to you and one or two other key caregivers.

  • A sense of you ‘belonging’ to your child. This can feel like ‘ownership’ or possessiveness, but is based on a strong sense of unconditional belonging.

What it looks like:

  • This stage can be clear to see when our children start using the phrase “my _____”. “My mommy”, “my cup”, “my toy”, and “my baby” are frequent at this age. Often, this age coincides with the birth of a baby which can make children feel even more possessive of parents and cherished things. Eventually, this sense of belonging extends to the new baby too, though this takes patience and time to get there!

How can parents support this stage:

  • At bedtime, belonging and a sense of loyalty can be supported through continued bedtime rituals that strengthen your child’s sense of safety and unconditional love.

  • Urie Bronfenbrenner, father of attachment, has said that every child should have at least one adult who is crazy about them. Enstilling a sense of unconditional belonging supports this stage of attachment.

  • Leaning into the need for your presence and for feeling the need to belong allows a child to relax in the reassurance that you and they are a family unit. It may also help them feel, over time, less concerned about how a new sibling can threaten this feeling of belonging.

  • This is a great age to consider shifting children to their own bed or own bedroom. Pulling the space together for them and focusing on phrases like “your room” and “your bed” can be helpful. Follow through by respecting that space and protecting their space from siblings in order to maintain this space as something that belongs to them.

In closing:

Consider these stages ‘signposts’ of attachment development, rather than as set-in-stone measures of attachment. Use them to guide your parenting, to anticipate your child’s needs, and to take pleasure in the ever changing emotional landscape of childhood! It can be quite a ride.

Next month I will add stages 3 to 6. If you don’t want to wait, you can view my 5-8 minute videos describing each stage of attachment via my facebook page. Stage #3 is a stand alone stage pinned at the top of my facebook page, but the rest of the videos are all in a folder together (securely attached!).

If you want to understand more about how to use the Stages of Attachment to strengthen your child’s sleep routine, or want to explore other shifts in parenting and the environment that can support infant sleep development, I welcome you to connect with me via email or phone.

If you want to read or learn more about Gordon Neufeld’s approach to attachment and child development, I recommend his book, Hold Onto Your Kids (co-authored by Gabor Mate). I also highly recommend the online courses offered through the Neufeld Institute, most especially Making Sense of Preschoolers.

Guest Writing on Motherhood and Sleep Deprivation

I have been less active on the blog front lately, but have certainly still been writing.

You can find my most recent writing in the following places:

  • Kathleen Lockyer’s RxOutside.com, a website and Occupational Therapy practice dedicated to using access to nature as a means for improving health and wellbeing. (March 11, 2019).

  • Rachel Marie Martin’s FindingJoy.net compilation from writers and entrepreneurs on what we would tell our 20 year old self about motherhood. (February 4, 2019).

And soon, a review in Occupational Therapy Now magazine of the book “Broccoli Boot Camp”, which focuses on evidence-based strategies for solving picky eating. This book adds valuable strategies to my approach to supporting families when mealtimes are not going quite as well as they pictured.

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Book Review: Sweet Sleep -Nighttime and Naptime Strategies for the Breastfeeding Family

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La Leche League’s 2014 book, Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, is a book for families of infants which focuses on attachment-oriented research evidence and strategies for understanding and addressing sleep challenges.  The intent of the book is to provide breastfeeding-friendly infant sleep knowledge, support, and problem-solving and, as I describe below, the authors have succeeded in meeting this aim.  

Writing in a calm, articulate manner, Weissinger, West, and Pitman are appealing to educated and informed parents who are at least somewhat familiar and open to attachment-based parenting approaches to sleep.  Likely the La Leche League publication naturally draws the attention of those already inclined to providing nurturing measures, in general. Although not an academic paper, the level of education required is rather high.  The book’s strengths lie in its use of evidence and research balanced with clear descriptions and case studies that highlight the key points.

It is quite a lengthy book that takes several hours to read, something that may be a challenge for all but the most motivated sleep-deprived parents.  Despite this, the depth and quality of the information and evidence provided make this my new primary recommendation to clients who are keen to read about infant sleep. Unlike other books on infant sleep, this books looks specifically through the lens of breastfeeding. However, it is still appropriate for non-breastfeeding families if shared in a sensitive way to those not currently struggling with breastfeeding or with previous decisions/necessity of weaning.  There is enough valuable information to firmly entrench this as an infant sleep book for professionals to consistently draw from when providing eager parents with detailed information or references scientific evidence.

Reading this book now, as a weaned mother of three children who now sleep well, I was so excited about the evidence they include that supports attachment-based sleep support for families.  In particular, their section on bedsharing (detailing La Leche League’s Safe Sleep Seven principles) is both evidence-based and instinct-focused: you, as a parent, must weigh the information available to you in the context of your own infant, yourself, and your family.

The references and citations are the real strength of this book.  Subtitles and indexing make it fairly easy to navigate the kindle version. The richness of the content makes it likely that families would benefit from a print version, rather than kindle version, in order to mark particular sections and to use the index more freely. I suspect most families who are so inclined will have print versions decorated liberally with sticky notes.



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Let's Talk About Pee.

Mannekin Pis, bronze statue in Brussels, Belgium. Pixabay.

Mannekin Pis, bronze statue in Brussels, Belgium. Pixabay.

After sleep, and perhaps after discipline, potty training is next in line as one of the likely questions you’ve had (or will have!) about raising your wee ones. Aside from it being a rite of passage for our kiddos, moving beyond diapers is also a big leap for us as parents. When our children stop using diapers and start regularly using the toilet:

  1. We cut down on purchases and on garbage (extra garbage tags, anyone?);

  2. We spend less time dressing and undressing, wiping, and washing the kids.

  3. We have more freedom on outings, even if initially we are simply trading diapers for a portable potty seat.

  4. And we can relish in a significant milestone that shows us our little ones, regardless of how many other ways they need our support, are developing and growing up.

Getting to that point of diaper free, however, is not like stepping through a single doorway. Just like with infant sleep, it is a developmental skill that is complex and cannot be rushed without consequences. Below are strategies for approaching toilet learning with kiddos. And, as with all things parenting, we can begin setting the path right from birth.

  1. “R.E.S.P.E.C.T.”. Awareness of and respect for one’s own body (and all its bodily functions!) starts with how others treat us. Telling your little one what you are doing as you do a diaper change is a simple and yet helpful way of reminding us (and teaching our children) that we respect them.

  2. Pay attention to patterns. Whether you approach peeing and pooing from the perspective of Elimination Communication, or whether you have a toddler with longer periods of time between wet diapers, or an approaching enrolment date for kindergarten, being aware of body language, timing, and triggers (how many pee-infused baths have your kiddos had?!) is helpful.

  3. Each in their own time. Although there are general trends on when children are able to use the toilet regularly for peeing, the age at which children are ready varies so widely that these age ranges are usually not helpful. With the exception of identifying medical, neurodevelopmental, and emotional barriers to toilet learning, the age when most kids are toilet trained may not be helpful in appreciating when your child is ready. Paying attention to signs of readiness, instead of age, can be helpful for taking the pressure off and for respecting your own child’s development.

  4. Model the outcome you want. Kids who see how the toilet is used are more likely to imitate its use, even at the age of one. Consider pointing out why you are using the toilet, and perhaps even invite your toddler to flush! But be prepared that modeling your behaviour might transfer over to putting other things in the toilet —a plumber once told me that in one troubled toilet he found an entire mini collection of playskool people. Pens are surprisingly effective at causing all sorts of back ups (this from personal experience —oh what chaos one little pen can cause). And no one wants their toothbrush to make its way into the bowl. Take it in stride. And keep a plunger nearby!

  5. Offer it and they will pee. Eventually. Having available a potty or an accessible toilet seat (including this one that is built right into the adult seat) along with an appropriate step stool can encourage children to spontaneously try toileting. Getting a potty long before your child is ready results in it being as natural a part of the bathroom as the toilet itself. For kids who don’t like dramatic change, this may be helpful.

  6. Pomp and Circumstance. For kiddos who love to have their milestones celebrated in style, novelty toilets with their favourite characters on it may help. But more importantly, the positive and genuinely pleased approach you take towards their learning may make a longer term impact (and transfers over into all sorts of achievements and milestones without the need to surround yourself with Paw Patrol paraphernalia). Being interested and excited—without been too interested and excited—may take some trial and error. Knowing your child’s temperament, and what works for them in terms of your reaction to other achievements, can help guide you.

  7. Go with the Flow. Whether your child goes diaper-free or bottomless for three intense days in the winter, or for two months in the summer, there will likely be wet clothes and pee on the floor at some point. Cleaning it up without chastising, and (if you can muster it without it seeming like you are punishing them) recruiting their help in a calm way is important for avoiding shame and embarrassment about a tricky developmental skill that will inevitably have its ups and downs.

  8. Know when to hold’em… know when to walk away. If things are not going so smoothly, it is often a sign that they are not ready. Put the goal of potty training aside for a while, and return to it when there are other cues. If, however, you feel like there is more going on, pursue it with your doctor. Urinary tract infections can sometimes be symptom free and yet will cause all sorts of upsets to the progression of potty training.

  9. Natural Opportunities and Oops’s: At one point in the gradual transition to full toileting with my first born, I found myself at a park ten minutes from home when he had to go pee —and we had not brought a diaper with us. This was the first time in the toilet-learning process that he’d been away from home for toileting and he wasn’t so gung ho about the idea of peeing in the public washroom. I offered a choice: he could either pee in the public toilet or we go home right away for him to pee there and remain at home. Although not initially happy with this choice (it was a beautiful day at the park, but boy oh boy the toilet at home was familiar) he weighed his options and chose to give the public toilet a try. It worked! We got to stay another hour, and he overcame the milestone of using a washroom other than our own. The next week, however, at the same park, we ended up with a surprise wet pair of pants. Sometimes natural opportunities (or genuine forced choices) help us make progress. But it’s not always linear.

  10. Dry Nights. If dry diapers at night seem like a distant dream, and you feel like it ought to have happened already, consider constipation. If children are backed up (even if they are pooping every day), it can cause night wetting. If you feel this may be a factor, an x-ray can confirm it, and strategies can be put in place to get things flowing better. Once the bowels are emptying easily and fully, there is less pressure on the bladder and ureter, and more ‘room’ for developmentally-appropriate night dryness. Resolving constipation will also set the stage for smooth transition to toileting for bowel movements too.

When Hurdles Get In the Way

There are a number of situations that delay toileting or that prevent independent toileting. Mobility issues, neurodevelopmental and social-emotional challenges, frequent UTIs, and cognitive delays can impact a child’s ability to progress towards independent toileting. Whether these hurdles are resolved over time (e.g. cognitive development or resolving UTIs) or whether these hurdles remain, respecting a child’s developmental, emotional, and physical abilities is crucial. By appreciating what the challenge is, we as parents may work towards remaining calm about the goal, the timeline, and the barriers.

This patience and acceptance includes when the child is ready and willing emotionally and yet is unable to achieve this milestone, and vice versa —when the child appears physically able but is not emotionally ready.

Signs Your Child May Be Ready for More Progress to Toileting:

  1. Their diaper remains dry for a greater length of time;

  2. They pause activity and take a pee posture (or expresses to you verbally that they are peeing in their diaper) that lets you know they are peeing willfully;

  3. They show an interest in the toilet, especially if it involves imitating you. (However, imitating can happen long before a child is ready physically.) Encourage this imitation, even if it doesn’t ‘yield results’. Toilet habits are a nice thing to develop, if led by your child, even before toilet use is consistent.

Should I Use Rewards to Encourage Toileting?

I generally take an “Alfie Kohn” approach to rewards (see his book Unconditional Parenting for his perspective on rewards and punishment): rewards usually coerce compliance rather than support the development of a skill. Although a well-timed encouraging gesture can tip “almost ready kids” solidly into the “totally potty-trained” category, rewards tend to assume that all the pieces are in place for success, and that all the child needs is a sticker or toy or chocolate to achieve the milestone. This is not usually the case. Kids are built to want to develop new skills. If they are resistant to developing a new skill then perhaps (a) they are not ready yet and a reward will frustrate, rather than motivate, or (b) they are relying a lot on this skill being your priority rather than a priority that comes from within. Occasionally, a reward to sweeten the deal can be helpful in cases where there is a lot of fear —the extra motivation to overcome that fear might help. But in my view, we ought to use rewards sparingly.

All in Good Time

Generally, as with most developmental skills, if we as parents provide the environment (nurturing, supportive, with opportunities for development, and access to the right tools -e.g. a potty!) children will develop new skills when they are developmentally ready, including toileting. If the timing is right, this happens smoothly, albeit gradually and with set backs along the way. And although there may be pressure to speed things up and rush the process, we can remind ourselves that, just as with learning to walk, most kids will get where they need to go when they are ready.

Resources

Alfie Kohn, Unconditional Parenting

Built-In Potty Seat, amazon.ca

Mannekin Pis, bronze statue in Brussels, Belgium. Credit: Pixabay.

Mannekin Pis, bronze statue in Brussels, Belgium. Credit: Pixabay.