Children biting is a normal sign of social experimentation

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by dr_som, MD

I love to pick up my two year old from daycare. Her language is becoming increasingly complex with small sentences, lots of gesturing and expression. When I ask how school was, she says, “Miss you. I crying.” Or, “I running fast with friends.” Or sometimes a confident, “good,” with a head nod.

Yesterday, she said, “friend, bite me.”

Her very kind teacher confirmed the event, and asked my daughter to show me the mark. No broken skin. No big deal. I reassured the teacher. I signed the incident form.

My daughter told me, “Miss Jean hold me and wash it. Tommy time out.”

I continue to marvel at the calm and skill of good daycare teachers. Miss Jean provided the proper hygiene, comfort, and discipline without yelling or blaming. I did not even ask what lead up to the incident because it did not matter. Asking my daughter why Tommy bit her would serve no purpose. Biting is never justified, and how can she speculate about what he was thinking.

I wanted her to learn forgiveness. I said, “You bite mommy and daddy sometimes. I bet he said sorry. You are OK. He’ll use his words next time.”  She nodded yes.

When infants mouth objects, we think nothing of it. Parents know it is normal for children to put things in their mouths. Most children start this oral behavior around 4 months of age and stop anywhere from 9 to 18 months with the behavior becoming less frequent as they learn more about the world through other methods. Biting other children or adults begins when chewing on other objects slows. Around this same time children are increasingly aware of social behaviors and are both curious and a little anxious about interacting with other people.

Biting is very natural and all children around the age of 12 months begin to experiment with biting Mom or Dad. Then they might try biting siblings or friends. The behavior peaks around 24 months and then declines. Three year old children rarely bite because they have gained social competence and the language skills to mediate frustration.

Please know that all children bite. No matter how you handle the behavior, your child will outgrow it by three years old. How you react may affect how quickly the behavior stops.

To nip it in the bud

  • A simple, “biting hurts” will do. Nobody should be called bad. No shouting.
  • Give affection and attention to the child that was bitten.
  • Briefly ignore the biter. Time out may not be necessary as ignoring the child sends a clear message that biting is an antisocial behavior.
  • Let the biter say sorry or hug the person he has hurt.
  • Anticipate biting and offer distraction or offer words that the child can use instead.
  • If the skin is broken, see your doctor about the need for antibiotics or a tetanus shot. Usually soap, lots of water, and maybe a cool compress are all you need.
  • Choose a daycare with good staffing ratios, at least one adult to four children for toddlers. A quality provider engages the children, minimizes boredom, recognizes fatigue and understands that biting happens.

Biting is almost never a sign of abnormal development in an otherwise normal child. My autistic child never bit anyone, but my five year old used to and my two year old still does.

Biting is a sign of normal social experimentation. I just hope I can keep that in mind when my daughter comes home with her first hickey.

“dr_som” is a pediatrician who blogs at Pensive Pediatrician.

When chronic illness strikes: Tips on talking to family and close friends

by Toni Bernhard, JD

In the summer of 2001, I was preparing to begin my 19th year on the faculty of U.C. Davis School of Law. Then I got sick with what the doctors thought was an acute viral infection. I have yet to recover.

Being diagnosed with a chronic illness or condition can take a toll on your relationships, partly because all of the affected parties are confused and scrambling to adjust to this drastic and unexpected change in your daily life. It’s a crisis—for you and for those who are close to you.

Here are four tips to help you communicate more skillfully with loved ones when chronic illness becomes an inescapable part of your life.

  1. Get help from a neutral third party. Often the best way to educate family and close friends about your diagnosis is to use a third party source because it takes the emotional component out of the equation. There are online organizations and associations devoted to every chronic illness or condition. Once you find them, you can forward links or print out pages for loved ones to read. If you have a book about your illness, photocopy the chapters that cover what you’d like your loved ones to know about your new life. (I did this for my close friends, attaching a short explanatory note to two chapters that I copied.)
  2. Write a letter. If loved ones are not being supportive even after you’ve tried to educate them about your illness, write a letter to them. Describe what your day is like now, and express how you feel about this unexpected change in your life. A friend of mine wrote a letter like this to her mother when, despite their many conversations about her illness, her mother persisted in saying things like, “If you’d just get up off the couch and go out and exercise, you’ll be fine.” The letter transformed their relationship. Now her mother is one of her main sources of support.
  3. Find non-illness related subjects to talk about. I had to learn how talk to others as a person with a chronic illness. At first, I assumed my family and close friends would want to know everything about my illness. After each doctor’s visit, I’d send them a long email describing the appointment in detail, medical jargon included. I’d get back a supportive sentence or two. It took several years for me to realize that my relationship with them would be more enjoyable and richer if I didn’t always talk about my illness. Now I ask about their lives and talk about new interests that I’ve developed. It provides all of us with a much needed respite from thinking about my illness all the time.
  4. In the end…accept their limitations. Some family and close friends may never accept this change in your life. Try to recognize that this inability to accept you as you are now is about them, not you. Your medical condition may trigger their own fears about illness and mortality. You can’t always fix how others think of you or treat you, but you can protect yourself from allowing their lack of understanding to exacerbate your symptoms. The best way to protect yourself is to cultivate compassion for them. If you can learn to wish them well despite their inability to support you, you can free yourself from the mental suffering that arises from your desire for them to be different than they are. The physical suffering that accompanies chronic illness is difficult enough without adding mental suffering to it.

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Everyone (including yourself) needs time to let this life-changing circumstance sink in. Hopefully, these four tips will make the road to acceptance less stressful.

Babies often get overdoses of prescribed narcotics

By Fran Lowry

NEW YORK (Reuters Health)  – Infants and children being treated with narcotics routinely receive overdose amounts, according to a study presented in Denver this past weekend at the annual meeting of the Pediatric Academic Societies (PAS).

Narcotics are usually given to young children in liquid formulations, which are difficult for parents to measure correctly. Also, pharmacists may not account for the child’s weight when prescribing, said Dr. William T. Basco, Jr, from the Medical University of South Carolina in Charleston.

“Narcotics involve a large proportion of drugs that are most commonly involved in adverse drug events and we also know that parents have problems properly measuring liquid preparations, so taking those two factors together, we wanted to find out more about the frequency of potential overdoses in young children,” Dr. Basco told Reuters Health.

He and his colleagues identified the top 19 narcotic-containing drugs prescribed for children aged 0-36 months from a review of 2000-2006 South Carolina outpatient Medicaid data. They calculated the expected daily dose of the narcotic based on Centers for Disease Control and Prevention growth chart data to impute the weight of each child as the 97th percentile based on age and gender, and then compared that dose with the actual amount of narcotic dispensed by the pharmacy.

During that time, there were 149,791 prescriptions for narcotic-containing preparations, for patients with a mean age of 18 months.

“Most of these prescriptions were appropriate, for post-operative or post-trauma pain. Some were for antitussants, and I think that is an important point to emphasize,” Dr. Basco said.

Fifteen percent of the prescriptions contained an overdose quantity of narcotic, the research team found. The average excess amount of narcotic dispensed was 53% more than expected.

The researchers also found that the younger the children, the more frequent the overdoses. More than half (61%) of infants aged 0 to 2 months who received a narcotic got an overdose, compared with 35% of infants 3 to 5 months old, 17% of infants 6 to 11 months old, and 8% of children 12 months or older (p<0.0001).

Younger children also got larger overdoses. Compared to expected doses, actual doses were 90% higher in the 0 to 2 month age group, 53% higher in the 3 to 5 month group, 36% higher in the 6 to 11 month set, and 34% higher for babies 2 months and older (p<0.05).

In addition, the youngest infants were dispensed more than twice the expected quantity 20% of the time. In comparison, infants 3 to 5 months got more than twice the expected quantity 3.8% of the time, infants 6 to 11 months, 1.5% of the time, and for children 12 months or older, it was just 0.2% of the time (p < 0.05).

“Clinicians need to remember that the younger the child, even small deviations from the appropriate dose will make a big difference,” said Dr. Basco. “Giving 20% more drug when you are 5, 6, or 10 years old doesn’t matter as much, but when you are a 2-month-old, then it matters a lot.”

The sedative effects of the narcotics can cause young children to stop eating and drinking and become dehydrated. “Very few would die from overdose but that is possible, but the greater issue is dehydration and this is harmful,” Dr. Basco said.

He added that, ideally, all pediatric prescriptions should be based on the child’s weight.

“For inpatients, our hospital pharmacy will not send any drugs to the floor unless the child’s weight is on the order, but ambulatory prescriptions that you get at Walgreens or CVS do not consider the child’s weight,” Dr. Basco added.

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