children

Video Blog! Helping Children Get To Bed (and stay there) - The Bedtime Pass Technique

Utilizing a Bedtime Pass

A “Bedtime Pass” is a strategy that you can use with young children (approximately ages 3 to 10) who have a difficult time going to bed on their own, or staying in bed once they have been put down. It’s best used with children who do the following things after being put to bed: call out to parents (e.g., “Mom, I love you.” “Can you come back in?”), cry or yell, or actually leave the room.

It is important to note that for children under two or over ten, this may not work.  Also, it may not be best for children who have lots of behavior problems at times other than bedtime. For these children, other things are probably needed first, before working on the bedtime routine.

 

Using the Bedtime Pass is a multi-step process. Below is an outline for your to follow:

 

1)    Sometime before bedtime on the night that you are to start the program, sit down with your child and explain the procedures. These are the important points to cover:

 a.     Explain that your child is having some difficulty going to sleep on his or her own and that you have come up with an idea of how to help. (e.g., “I know that it’s hard for you to go to bed on your own. So, I’ve made up an idea that may help you.”).

b.     Explain the strategy. Say something like, “You and I are going to make a pass for you to use each and every night. You will get one pass per night. After mommy or daddy puts you to bed, you can use the pass for one free trip out of the room, for some purpose. The reason has to be short and to the point. For example, if you want one last hug or one last trip to the potty, that’s fine. If you use your pass, then you need to give it to mommy or daddy and go straight back to bed.” Stress that it needs to be a short, specific reason (5 min or less).

 c. Explain what should happen after your child uses the pass. Say something like, “After you use your pass, you need to go back to bed and stay there for the rest of the night.”

2) You and your child should now make the pass. You can use 3x5 or 5x7 note cards, thick cardboard cutout to about the size of a small photograph, or some similar material. If you used note cards, you might want to tape several together to make the pass sturdier. Allow your child to color, write on, or otherwise make the pass his/her “own.”

3) Just before bed, hand your child the pass and remind him/her of its purpose. Follow your typical bedtime routine and then leave the room.

4) If your child requests to use the pass, allow this and then take the pass. Send your child back to bed, reminding him/her that it is now time to stay in there and be quiet.

5) If your child calls out AFTER using the pass, ignore this behavior. Even if s/he escalates, continue to ignore the behavior.

6) If your child comes out of the room AFTER using the pass, physically guide him/her back to bed with no/minimal interaction.

7) For the first few nights when you are using the pass, remind your child of the rules of using the pass, give him/her a pass, and follow the same routine. Increasing the Success of the Pass: For many children, simply using the pass will be effective in decreasing bedtime behavior problems. Of course, you will want to verbally praise your child for using the pass and for going to bed like a good boy or girl.

For some children, the pass may result in some improvement, but not as much as you’d hoped for. In this situation, you may also need to add an extra incentive for using the pass.

 

Examples might include:

1) Letting your child pick his or her breakfast (within reason, of course) on mornings after not having any bedtime behavior problems.

2) Offering an afternoon/after school treat when your child didn’t call out or leave the room at all.

3) Providing an opportunity to reach into a grab bag with small treats each morning that there was no resistance.

4) For older children, you can make the rewards more long term, like staying up later on Friday if there was no or minimal bedtime resistance during the week.

Remember, if you are offering incentives; make sure that your child only gets them when there is no bedtime resistance. Also, think about providing more rewards at first, and then decreasing the rewards over time.

Three More Bites! End Mealtime Madness and Promote a Child's Healthy Relationship with Food

Written by Kaitlyn Jue and Dr. Elizabeth Adams 

I used to dread lunchtime at school.

Managing 14 young children, the contents of their lunches, guiding them to make healthy choices, and ensuring that they all ate enough seemed like an impossible task to take on at noon every day.

Because it was.

I reached a point where this approach didn’t feel right anymore.

There are many days when after eating part of my own lunch, I realize that I’m not hungry enough to eat all of it. On other days, I eat every last bite. There are days where I intuitively want an apple first, while other days all I can think about is enjoying my sandwich/salad/other “main dish” before anything else.

Children have, and will follow, these same intuitions if we give them the time, space, and opportunity to do so.

Current research suggests that much of the conventional wisdom related to how we interact with kids around mealtime is actually counterproductive to meeting health and nutrition goals.  For example, it is so common to see parents pressuring kids to eat their meals. This can take many forms with young children, but parents often encourage their kids to “take a few more bites,” using treats as an incentive to eat more of the presented meal, feeding kids that are able to feed themselves, or resorting to arguing, bribing, yelling, and even punishment as a means to entice more food intake. This desire to pressure children to eat is generally driven by good intentions of the parent - they do not want their child to be hungry or uncomfortable, and they worry about providing them proper nutrition.  

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A study published in the Journal of Nutrition Education and Behavior found that children who were pressured to eat consumed significantly fewer fruits and vegetables and ate significantly more foods with less nutritional value compared with children who were not pressured to eat.  Ultimately, the goal for our children is that they are able to make appropriate decisions about food independently, and are able to look to their bodies regarding cues about hunger. When parents put too much pressure on children, we aren’t giving them an opportunity to read their body signals, or develop the capacity to make independent choices about food and regulating what they eat.  Battles also result in frustration and negative feelings about food and nourishing our bodies.

Changing our approach

In November of this past year, we worked together to begin exploring what would happen if we released the micro-management of meal times at school. One day, completely “cold turkey,” we stepped back and let our students take the lead.

Using evidence-based practices, our new approach to lunch management empowered the children to make their own choices about what they ate from their lunch, in what order they ate it, and how much they ate.

One common practice around mealtimes is having children eat a certain amount of a meal in order to get a dessert or treat (e.g., “Take three more bites of your chicken then you can have your brownie”).  Nutritionists suggest that this practice encourages kids to be less mindful of what they are eating. Psychologically, it sets up the meal as a “chore” that kids have to muck through in order to earn the “prize” at the end of the meal, rather than teaching kids the value and appeal of a variety of foods, and how to make choices in a food landscape where lots of choices exist.  This is especially important since children have an immense amount of control over their diets as young as elementary school when many of their choices over food choices, the order of consumption, and amount of intake are generally independent.

In our classroom, given our new approach, when a child asked, “How many more bites of [insert food type here] before I can have my treat?” We’d respond with “Listen to your tummy and choose what you think will help it feel best,” as opposed to providing an ambiguous number (“three more bites”), which is what I had done for years.

At first, I’m fairly certain a few of the kids thought I was joking. And, as expected, there were a few students who dove straight for that “treat” as soon as their lunch boxes were opened. But, over time, I noticed my students speaking intentionally about their food choices and intuitive eating processes with increased mindfulness and confidence.

One day, after taking two bites from a cookie, one student shared, “I think my tummy is all done with my cookie today. I’m going to save it for when I get home.”

On another occasion, a different student was trying to determine what she wanted a bite of, she spoke, “Tummy, what do you want? Do you want the mango? Or crackers? I think my tummy wants both so I’m eating them together like a sandwich.”

 

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Helpful tips for managing mealtime (for teachers and parents)

We as adults are often fearful about allowing kids to take more control over their eating because we worry that children will make only unhealthy food choices, or that they will “starve” without the pressure to eat.  Physically “making” a child eat is not possible, and most toddlers figure out very quickly that this is one of the few domains where they have a lot of control. Below are a few tips to help you work with your child in developing healthy eating habits, and making fueling the body a positive experience.

1). Have developmentally appropriate expectations regarding quantity intake. Parents often pack too much food for young children, and then are dismayed when a lunchbox returns home half-full.  Education regarding typical and nourishing amounts and types of food for growing children is an appropriate place to start!

2). Present a variety of foods, including somme options you know your kids will eat. Repeated exposure to new and healthy foods is key!  One aspect parents can control in many mealtime situations is what food is offered.  Focus on offering a variety of options, and give your child the control is choosing which of the foods they will eat, and how much of each they will eat.

3). Be mindful of what you focus on. It is far more important to talk about food in terms of fuel, and the positive aspects of different foods, instead of labeling foods as “good” and “bad.”  Use mealtimes as a time to also focus on connection and being together, and make the presence of your child at a family meal mandatory, rather than making a certain number of bits the mandatory focus.  Encourage kids to listen to their bodies, and recognize cues about hunger and fullness. Praise trying new things and kids expression of paying attention to signals, rather than praising eating certain amounts or avoiding certain foods.

4). Relax! Taking the pressure off takes some getting used to, and can activate anxiety in parents and caregivers.  Rest easy that children may learn from a natural consequence of being hungry if they choose not to eat at dinner (tip:  set the dinner aside for later, or keep fruits and veggies on hand as “anytime food” if they indicate their tummy is telling them they are hungry!). These learning experiences of cause and effect will help them to grow and understand how to read their body’s cues, and respond accordingly.

For more tips on developing healthy eating habits at home, see our evidence-based infographic below:

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Mealtime should be a positive experience for the family; one that is focused on fueling bodies, and connecting over a conversation and a shared meal.  In the landscape of “picking battles,” micromanaging food intake is likely a smart one to give up - and you may be pleasantly surprised by the outcome.

Remember that what each child needs is different.  Dr. Adams provides individual (Skype or phone based) parent coaching to address a range of concerns (e.g., sleep struggles, tantrums, limit testing, co-parenting issues).  Email Dr. Adams for more information, or to schedule an appointment at dradams@personalizedparenting.org, or learn more here:  www.personalizedparenting.org.

Parent Coaching?!?....Why not just ask your Mom?

A few months back, a friend and client of mine shared the Personalized Parenting website on her Facebook page, and received a comment: "Lol....Don't you know this stuff yet? There seems to be a doctor for everything??? Just ask your mom how it's done!"

I have engaged in lots of healthy dialogue about the process of parent coaching, and this isn't the first time that I have communicated with someone who initially responds to the idea with skepticism, resistance, and misunderstanding.  

I hear from a lot of people that the concept of reaching out for advice on "parenting" seems very strange to them. In my experience, this usually means that the person who feels this way has the lucky experience of a supportive network, or a child with an easy temperament, or just doesn't feel like this is an avenue of support that is right for them. I have, and continue to work, as a licensed child clinical psychologist providing traditional services to children and families. And I love that work, and have had the pleasure and honor and supporting families through difficult times. I found in that work, however, that there was an underserved need for parents to connect and get reliable support for situations and challenges outside of the traditional context of therapy.

Being a parent can be challenging, and just like any challenge in life, I applaud and support those that ask for help during those times (in any form - including asking their mother). There is not only one way to seek support, to learn, and to be a parent. I believe that mother's have a wonderful, insightful perspective on parenting, and they can give very helpful advice. I would not say my support is "better" - it is different.

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I can say that the parents I have worked with sometimes find comfort in having an outside person offer them support. I have also seen that this support, while tackling some typical challenges, can really help a parent and a child. In the end, I think that each person has the right to maximize their happiness, and go about doing so in the way that feels comfortable for them. While the comment did not offend me, I am protective of the parents who ask for my help , and we shouldn't laugh at anyone who is seeking support. 

The conversation continued, with the commenter explaining her position further:  "I of all people understand we all need help. Here's where I'm coming from; I believe there is just too much outside advice today...my response to [original poster's name removed] was intended to mean that I know her upbringing and believe her to be a stable person whom, if uses her common sense, I know she wouldn't need a doctor to help her raise her children...So I guess I'm saying that we all could stand to take the advice of our mothers, grandmothers etc verses a stranger who has "clinical" experience. It's not rocket science. It's consistency and love that wins in the end! It's also not easy. It's the single hardest, sometimes loneliest but fulfilling job on earth! In this world we live in today, everyone's looking for the easy way out or for someone to tell them a better way...There are too many cooks in the kitchen people! Parenting is hard. Use your God given common sense to raise your children. Sorry if I've offended anyone."

My response included a great deal about my perspective regarding my work, my philosophy, and my beliefs about parent coaching, and I wanted to share it with anyone potentially seeking support: 

I am a big believer in the importance of engaging in healthy dialogue with those that disagree with us, so I am grateful for your perspective and the opportunity to talk about your points. First, I appreciate your explanation regarding your intention to not be mean or hurtful. Intentions are important, and sometimes we need to recognize that while our intentions might be in the right place, our actual words and actions might be hurtful.

My primary concern is actually that some of the sentiments you shared could be hurtful to parents who are seeking support. In that vein, I want to address a few things and share my perspective. We can often build bridges with those we disagree with by starting with a focus on what we share in common - and we actually agree on a fair amount. First, please know that I consider myself a fierce advocate for parents and mothers. My work does not at all imply that I believe they are unstable, incapable, or there is something wrong with their children. Quite the opposite. I find that parents who are willing to reach out, learn more, and ask for support when needed are some of the most capable, brave, and strong parents I know. I have endless admiration for the parents I work with.

Secondly, I agree that there is an unbelievable amount of advice about "how to parent" out there today. Amazon alone carries over 6,000 titles. This access to information can be overwhelming and confusing to parents. So, you are onto something there. And, science agrees with you - parents today, despite an increase in information, report more stress than any generation of parents before (partly because of that increase in information), and less certainty about decisions regarding parenting. To make matters worse, the most harmful kind of information is the type that only presents a single solution - sleep train vs. don't, potty train at 2 vs 3, and also - get support vs. don't get support.

The second most harmful kind of advice is that which implies that if parents can't figure it out - they are incapable. I can assure you that the majority of parents I speak with have read books, gone online, talked to their mothers, and friends, and still feel like something isn't working. I promise that if telling them to use their common sense was the solution - they would do it. When parents are overwhelmed by advice (often contradicting), and then told that it isn't "rocket science," they feel more hopeless, anxious, and more "like a failure." That isn't kind or helpful.

My work starts from the belief that parents are the experts on their child(ren). My work is actually not to give specific advice on "this is THE way" because it worked for me, or anyone else. I work collaboratively with parents to understand their unique children, their own values, their specific challenges, and we discuss (based on information about child development and research), some things that might be a good fit for them. This requires genuine support, a belief that the parent is capable, and serious, true, respect for a parents values (not my own values and opinions). I feel this way about all topics, and don't have a single agenda I am pushing. That makes it about the person who is giving the advice, not the person who is seeking support.

Finally, many of the things that arise in my coaching practice (vs. my clinical work) are things that would "pass on their own" - sleep struggles will end, the child will learn to use the potty - but when parents are in the thick of things, they might feel like it is a worthwhile investment in their happiness to reduce the stress by having someone to talk to. A parent relieved to have some strategy gets to enjoy all the joys of parenting a bit more - that's a win for everyone. A person who isn't going to tell them to do just the way they did it, who doesn't have an agenda, who isn't going to tell them to "suck it up," - but genuinely wants to help, can feel like an immense gift. If it reduces stress and brings more joy - I support it.

I have worked with mothers who have lost their mothers and don't have the luxury of their advice, or parents who DID try the well-meaning advice of others and are working SO HARD (and feel so frustrated that it isn't just "common sense"). These parents want someone to talk to about something that (in the moment) feels overwhelming and hard. If this isn't needed for someone - I celebrate that too, truly. My deepest desire is for ALL parents to feel supported and celebrated. As you said, parenting is hard. And I believe as women, as parents, as people -
we can only make it easier by supporting one another, lifting each other up, and respecting the MANY different perspectives and ways to parent.

Remember that what each child needs is different.  Dr. Adams provides individual (Skype or phone based) parent coaching to address a range of concerns (e.g., sleep struggles, tantrums, limit testing, co-parenting issues).  Email Dr. Adams for more information, or to schedule an appointment at dradams@personalizedparenting.org, or learn more here:  www.personalizedparenting.org.