pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

You Can’t Make a Kid…
Gregory Lawton, MD, Pediatrics, General, 10:39AM Mar 14, 2017

[Reprinted from Dr. Gregory Lawton, M.D., a pediatrician specializing in Asthma, Early childhood development and Attention Deficit Disorder (ADD) at Children’s Hospital of Philadelphia (CHOP)]

I am a remarkably slow learner sometimes. During the course of my pediatric residency, I remained convinced that the reason nearly every eighteen month old resolutely resisted my attempts to complete my physical exam could be attributed to some parental defect. It wasn’t until my own eighteen month old acted in the same manner when I tried to dress her or change her that I realized nothing was wrong with the parent (as if!!). That’s just how kids are.

More epiphanies became manifest, as my children aged into and through certain developmental stages. And so, without further ado, I give you A Musing Pediatrician’s truism triad, “You can’t make a kid…”

You can’t make a kid eat

(short of force-feeding them, to be sure, but I am NOT advocating this).

I cannot tell you the number of times I have heard some version of “so we make him sit there, by himself, until he at least tries a green bean.” Fun times at the Smith house to be sure. Why bother? The resolve of the average three year old in such a scenario will wash the floor with the resolve of the average sleep-deprived, stressed parent.

Try this. No snacks or drinks for about one hour before a meal. Place an empty plate before each family member, including said “stubborn” child. Place the serving bowl or plate in the center of the table and each family member chooses what and how much to place on their own plate. Choose smaller serving spoons for the “high demand dishes” and larger ones for lower demand ones. Announce that you are setting a timer for twenty minutes, the length of a typical family meal. When the timer goes off, plates disappear and the meal is over, for everybody. Then, sit, eat, talk about the day. When the timer goes off, follow through, regardless of what has been eaten, or not, by said “stubborn” child.

Now, if they don’t eat, they experience hunger. Fortunately for them, there will be another meal later. (Your child will not wither away for want of calories and I won’t call Child Protective Services on you.) As long as you don’t cave in and let them snack until the next meal, you will have illustrated for them a valuable association between the choice not to eat and the consequence. It’s called hunger.

In a nutshell, you can’t make a kid eat, but you can help them learn to make the most of their opportunity to eat by allowing them to experience hunger.

You can’t make a kid fall asleep

(short of medicating them, to be sure, but I am NOT advocating this).

Here’s the deal. The kids are the house, the deck is stacked against you, and so you’ve got to play a weak hand using all of your parenting acumen. For babies, make sure the belly is full, the diaper is empty, and that they are truly tired. Your advantage is at the beginning of the night. That’s when you are in more control. Try not to allow your baby to fall asleep while feeding; you want them to be sleepy but awake when you put them down. Put them down to sleep in the same place in which they will eventually wake up, otherwise it’ll be the equivalent of us falling asleep in the Westin and waking up in the Super 8. Pretty disconcerting, huh? Same with babies. Now is the time to start with a routine and make it a ritual. Bath then bottle then books then kisses then bye-bye.

I tell older kids, “NO electronics.” These gizmos are designed to keep you interested and engaged. Sleep is part fatigue, part relaxation, and part boredom. Don’t tell me you need to watch YouTube clips to fall asleep. What you’re telling me is that you need constant distraction. Get back to a ritual, modified for the older kid.

Some kids fall asleep more easily that do others, that’s hardwired. So while you can’t make a kid fall asleep, you can consistently set the conditions that are conducive to sleep by focusing on the conditions associated with the rituals to help them recognize the essential ingredients of sleep stew – fatigue, relaxation, and boredom.

You can’t make a kid poop or pee on the potty

(short of using an enema, to be sure, but I am NOT advocating this).

This play is simple, brilliant, and involves no speaking parts.

Step 1 – When your toddler turns eighteen months old, transfer all the diapers and wipes from that bin in the living room and that shelf in the baby’s room into the cabinet or basket in the bathroom.
Step 2 – Buy a training potty with a seat and set it in the bathroom.
Step 3 – Every time your child does something that necessitates a diaper change, take them to the only place in the home where there are diapers and wipes.
Step 4 – Change them in the bathroom (or as close as possible). That’s it.

Here’s one last reality. If properly (mis)motivated, your child can hold onto that wad of stool in their colon for a period of time longer than your honeymoon. Your job is to make it easy for your child to do the right thing, when they are ready. You want them to “connect the dots” that the bathroom is this special room for contemplation and relief. So start by connecting all the dots in one place so that 5 to 6 times a day, 7 days a week, they are in the same room dealing with the same…(um, stuff). Soon they will be barging in on you during your own moments of contemplation. In a classic case of monkey see, monkey do, they will start to ape you with their own little training potty.

The key is, you cannot make them poop or pee on the potty, but you can create the space and the opportunity for them to do the right thing, but in their own time.

Parenting is about a lot of things, including power. Successful parents realize earlier the limits of their own power, accept these limits (it’s kind of liberating), and work the remaining options to the best of their ability. It’s our job as pediatricians to suggest and nurture these parental abilities.