Wednesday, November 25, 2009
The three games you play with your kids that you can never win

By Dr. Anthony Policastro

I spend a lot of time teaching behavior modification to parents. One of the things I teach them is about the three games you cannot win. These are three items which children have total control over so any kind of battle over them will be lost. The first of these is the eating game. There are parents who believe that they can force their child to eat. They think they can make them clean their plate. They think they can make them eat certain kinds of foods. If the child wants to fight this battle the parents cannot win it. I frequently have parents come to my office to complain about their child's eating habits. In almost every case, there is not anything wrong with the eating habits. The problem is with parental expectations. The first issue is the amount eaten. Children do a pretty good job of eating enough calories to gain height and weight. If a child is growing normally, he/she is eating enough. It may not be what the parent expects. However, it is what the child needs. Any issues with the amount of food eaten should be easily solved with a scale. If the child is gaining weight, then the amount is fine. The second issue is the type of food eaten. Most children balance their diet well. Those who do not eat meat get their protein from cheese. They become heavy cheese eaters. Those who do not eat vegetables get their minerals from bread. They become big bread eaters. Parents who are concerned about the type of foods their child eats can provide a multivitamin supplementation. That will make up for any potential issues with the diet. The second battle is the toilet training battle. There are two parts to this. The first is the actual toilet training itself. This should be something that the child and parent both want to happen. Some parents have issues with expectations in this area as well. The average age of toilet training is about two and a half years. Some children are ready before that. Some children are ready after that. Parent who expect their child to be ready at age 2 may find that their child is just average. In that case the child will not be ready. The battle lines are then drawn. The parent will always lose. Related to this is the actual procedure when a child is ready to be toilet trained. There are some parents who are too strict for their particular child. There are others who are too permissive. Both sets of parents will find that there will be toilet training battles. When children get older a different kind of battle might take place. A child may not go to the bathroom regularly. If their stools remain soft, then whatever frequency they have is fine. If the stools are hard, they might need the help of a stool softener. However, a parent demanding that their child use the bathroom will not work. The third battle is the sleep battle. Some children will not go to sleep when their parents tell them to. There are multiple reasons for this. Some children have learned to play their parents and stay up late. These are called children with poor sleep hygiene. A simple demand from a parent will not work. This requires a lot of changes to the bedtime regimen. It usually will benefit from some counseling assistance. A second group of children wake up in the middle of the night. They then have trouble going back to sleep. These children often have sleep association issues. The setup in the middle of the night is treated differently than the one at bedtime. For that reason, they just think it is not time to go to sleep. Bedtime must be mimicked to treat this effectively. A third group of children have an altered biological clock. They do not become sleepy until later in the evening. This is a problem at bedtime when they are not tired. This is a problem when they get up for school when they are still tired. These children will go to sleep late on weekends or school vacations. They will sleep in late in the morning. They get the right total number of hours of sleep. They just do it at the wrong time. Changing their inner biological clock is complicated. It will not respond to simple "You will go to sleep now". These are three battles that parents cannot win. However, it is interesting to see how many times parents decide to fight them anyway.

Unplug your toddlers from the TV

By Doug Tynan, Ph.D

A recent report from The Nielsen Company, the national provider of TV ratings and media information, found that kids aged 2-11 are watching more television than ever. In particular, children aged 2-5 are, on average, watching nearly 25 hours of television a week. An additional seven hours is spent playing video games and watching programs on DVD, DVR and other playback devices. Let's put this in perspective. A 3-year-old child averaging 32 hours of screen time per week comes out to about 4.5 hours a day. This same child should be getting 11-12 hours of sleep per night. That means nearly one third of his waking hours are spent in front of the television. Kids are young for such a short time, and they have an enormous amount to learn in those 12 waking hours each day. At age 3, kids are learning important and vital skills like taking turns, controlling emotions, and knowing "mine" from "yours." They are starting to express affection openly, playing make-believe, completing puzzles, making mechanical toys work and building things. Children need these skills for their physical, intellectual, and social growth - skills they cannot perfect parked in front of the television. Toddlers love to explore, touch and experience life first-hand. Kids are wildly creative. A simple game of make-believe can send them on an adventure right in their own family room, while helping them develop language skills, self-control and cooperation. Another recent report, in the Archives of Pediatrics & Adolescent Medicine, states 3-year-olds exposed to more TV may be at risk for displaying aggressive behavior. TV viewing has also been linked to obesity, bullying and can have a negative impact on academic achievement. While there's no doubt TV is a dominant force in our lives, it's also becoming clear that kids, especially our youngest ones, are watching way too much of it, leading to potentially negative outcomes. This doesn't mean you have to ban television altogether. The American Academy of Pediatrics recommends limiting kids aged 2 and older to a maximum of one to two hours per day. They recommend no television for children under age 2. So, of course, putting on a program for the kids in order to get dinner ready is completely appropriate. Using television as a reward is a great idea. But don't waste kids' limited "awake time" with TV viewing. Here are some idea starters for toddler activities that don't include a screen:

  • Plan a "game night." There are plenty of games designed for toddlers based on charades (acting things out), counting, and matching (colors, numbers, and pictures). You can buy them as board games or make up your own!
  • Have a "busy box." Fill a small box with crayons, coloring books, activity books, and other age-appropriate arts and crafts. When the "TV box" goes off, the "busy box" gets opened! Try putting different items in there so it's a surprise each time your toddler opens it.
  • Put on music. Whether it's music you like, or kid-specific, just turn it on, turn it up, and get 'em dancing.
  • Let your little one help around the house. Even toddlers can help sort laundry and get the placemats and napkins on the dinner table.
  • Play dress up. Old Halloween costumes are fun to wear all year round!
  • Take a walk. Whether it's around the block or at a nearby park, kids love to explore the outdoors all year round.

For more tips on limiting TV viewing, and other ideas on how to "unplug," visit

About the author Doug Tynan is the director of Program Development and Implementation at Nemours Health & Prevention Services. He is the former director of programs for children withbehavior and learning problemsand their families at AI duPont Hospital for Children.

Look Good program is Dec. 14 Women undergoing chemotherapy or radiation treatment for cancer can receive free professional help to cosmetically disguise the appearance-related side effects of their treatments. LOOK GOOD...FEEL BETTER, a program developed by the Cosmetic, Toiletry, and Fragrance Association Foundation, the American Cancer Society, and the National Cosmetology Association, trains volunteer cosmetologists to help women with cancer, conceal loss of hair, skin problems and other side effects that can result from cancer therapy. The next program will be hosted by the Cancer Care Center at Nanticoke Memorial Hospital on Monday, Dec. 14, from 5 to 7 p.m. at the Cancer Care Center's 2nd floor conference room. The program is free to all patients in active cancer treatment. Registration is required, and space is limited. To register, contact Nanticoke Memorial Hospital's Cancer Care Center at 629-6611, ext. 2378 or 2588.

Man to Man support group Nanticoke Memorial Hospital's offers a Man to Man support group meeting on the fourth Wednesday of each month. Man to Man helps men cope with prostate cancer by receiving information and peer support. Man to Man is a forum for men and their support network to learn about diagnosis and treatment options through presentations, written materials and videos. Specialists share information such as side effects and how to cope with prostate cancer and its treatment. News and information about nutrition, general health, research and treatment, as well as messages from men living with prostate cancer and other Man to Man activities, are offered to assist in the recovery process. Pre-registration is not required for this free support group. For more information, contact Larry Skala (337-3678) or Grafton Adams (628-8311).

New breast cancer support group Delaware Breast Cancer Coalition, Inc. (DBCC) has expanded its Beginning Your Pink Ribbon Journey, a program for women newly-diagnosed with breast cancer, by partnering with Nanticoke Memorial Hospital Cancer Center in Seaford. The free, monthly program is offered at the Cancer Center located at 801 Middleford Road, Seaford, the third Thursday of each month from 3 to 4 p.m. beginning Thursday, Dec. 17. The program is facilitated by Nanticoke Memorial Hospital Cancer Center professional staff - Terri A. Clifton, MS, NCC, Cancer Care coordinator; Mary Brown, RN, DSN, Manager Cancer Care Center; and Wendy Polk, nutritionist - with assistance from Lois Wilkinson, DBCC special projects manager, who helps facilitate the program at Bayhealth. Together, they answer questions, help calm fears, and share information about resources that are available at Nanticoke, through DBCC, and other organizations within the local community. Of particular value to newly-diagnosed women is DBCC's Peer Mentor Program through which they are paired with a long-term survivor for one-on-one support. To learn more about Beginning Your Pink Ribbon Journey at Nanticoke Memorial Hospital Cancer Center, call Lois Wilkinson at 672-6435. Registration is required and light refreshments and small gifts are provided.

State ensures screenings Delaware is the first state in the nation to require insurance carriers to cover medically appropriate developmental screening tests for children between birth and age three. The purpose of this new law is to dramatically increase the number of children whose developmental delays are detected at a very young age when they can be successfully treated. For kids covered by private health insurance, this change is expected to double the number who are successfully diagnosed with developmental delays at a very young age. The change in Delaware law is a result of House Bill 199, which was signed by the governor last August but allowed a 90 day period for insurance companies to prepare for its implementation. House Bill 199 was written by Lieutenant Governor Denn, State Representative Terry Schooley, and State Senator Patricia Blevins, and was part of the Lieutenant Governor's "Kids Agenda" this year.

Orthopaedic office opens in Seaford Peninsula Orthopaedic Associates has opened an office in Seaford at 11 Fallon Avenue. Dr. Anthony J. Adrignolo is returning to the community and joining him are Dr. David M. Roe, Dr. John J. Greco, Dr. Eric H. Franks and Walton Reddish, C.R.N.P. Peninsula Orthopaedic Associates specialists treat the spine, shoulder, elbow, hand, wrist, hip, knee, foot and ankle. Advanced computer-integrated medical records and imaging are featured at the new location. Same-day and next-day appointments will be accommodated whenever possible. For more information, visit or call for an appointment at 410-749-4154.

Stroke support group offered Nanticoke Memorial Hospital's next Stroke Support Group meeting is Thursday, Dec. 17 at 1:30 p.m. at Nanticoke Memorial's 2nd Floor Cancer Care Center Conference Room. The support group is designed for individuals who have survived a stroke as well as their families and caregivers. The two-hour support group meetings will consist of guest speakers and breakaway sessions, in which caregivers and stroke survivors will meet in two groups to discuss concerns, provide support, and allow for networking. Refreshments will be provided. Pre-registration is not required for this free support group. For more information, contact Nanticoke Memorial Hospital at 629-6611, ext. 8626.

Monthly support group Compassionate Care Hospice, The Wellness Community-DE and Nanticoke Memorial Hospital will collaborate to present a monthly bereavement group, The Next Step. The group focuses on issues of loss that continue beyond the early stages of grief. Mary Van House, bereavement coordinator, will facilitate the group at 10 a.m. on the third Tuesday of each month, at the Nanticoke Cancer Care Center, second floor conference room. To register, call Lisa at 629-6611, ext. 2378.

Hospice offers Grief Support group Delaware Hospice is offering an eight-week group meeting for adults who have experienced the death of a loved one. The group will meet Wednesday afternoons from 5 to 6:30 p.m., until Dec. 2, at Nanticoke Memorial Hospital, 801 Middleford Road, Seaford. Find out what normal grief "looks" like; learn about the "tasks of mourning;" identify your coping style and develop coping skills that feel right for you; share as much or as little as you would like. This activity is provided free to the public by Delaware Hospice; however, registration is required. To register, call Paul Ganster at 302-357-7147.

Depression Support Group There is a free bimonthly Depression Support Group meeting in Laurel on the second and fourth Wednesday evenings from 7 to 8:30 p.m. Any person who has signs and symptoms of depression and is under the care of a professional counselor/MD is welcome to attend. To register, call Life Matters Counseling and Consulting at 302-465-6612.