As a behavioral pediatrician, I see children with behavior problems. Kids with aggression, kids who have been kicked out of multiple daycares or schools and kids who are not doing well at home or school.
One of the things I always look for are clues as to why. Behaviors, while stressful, are not a diagnosis. They are symptoms of something else. For example: Just because a kiddo is not completing homework or cannot pay attention does not automatically mean the child has ADHD. This is what makes behavior and mental health in children so challenging.
There is no blood test or rapid swab test to perform that tells you with 100 percent certainty that a child has a specific behavioral/mental health diagnosis. And while some of these behaviors can run in families (such as ADHD, anxiety), we must always consider whether these behaviors reflect what is happening around the children. Sometimes it is just helping families tweak what they are doing when interacting and disciplining their children. However, sometimes it runs deeper than this. And the cause is not necessarily because the child is naturally choosing to behave this way.
Children look to their adults for comfort and security. They are always learning by watching and observing the words and actions their family members and friends do. They are sponges and take in everything. This is how we learn — through social interactions. It starts early with the social smile. The infant learns that when he or she smiles at his momma, she will respond in kind with a smile, a coo or a smooch. The infant squeals in delight and smiles again. This “serve and return” of social interactions between caregiver and infant lays the foundation for a healthy, nurturing and stable relationship and helps strengthen connections in the brain. We know that when caregivers are not able to muster the energy or are not sensitive to the child’s needs/cues, it can have negative effects on the brain connections that ultimately will impact a child’s physical, social and emotional health for their lifetime.
As parents, we are constantly role modeling behaviors to our children — the “good,” the “bad” and all the “in between.” In fact, teens who grew up in homes where their parents or older siblings smoked are more likely to take up smoking themselves. We also know that children exposed to domestic violence in the home and see parents who cannot resolve conflict peacefully are more likely to engage in bullying behavior. Not every child exposed to domestic violence will automatically become perpetrators, nor will every child who sees their parent smoke become a smoker. But it does raise the chances.
In pediatrics, we monitor the health and well-being of children. We check their growth. We support our families. We want to ensure parents feel competent and able to deal with those common issues that come up when raising children. To do this, we need to inquire about these other risk factors that can lead to behavioral problems and poor health. Just as we ask about allergies or how things are going, we also ask about how the parent is doing and feeling, how they are coping and if there have been recent changes to the family structure (for example, divorce or a death). We ask about domestic violence. And now given the tragic events happening in our world today, we must ask about exposure to virtual and real community violence.
This is why pediatricians may tell you to turn the TV off or not watch the news when children are around. Sure, we want our children to be citizens of the world, but exposure to the startling and horrific images can be unsettling. Parents can choose to talk with their child about current events after they have processed it first and have gotten over their own fears and made sense of it for themselves.
The “costs” of these exposures are not easily measured, but it can affect how our children grow and develop, how they behave and act. We know kids exposed to domestic violence have a higher likelihood of developmental delays. We know kids exposed to both domestic violence and parental depression may have higher risks of having a behavioral/mental health issue as early as in the preschool years.
Pediatricians, family physicians and pediatric nurse practitioners all care about one thing. They care about your child’s health and wellbeing.
We must ask those difficult questions because we want to know how to best support the entire family. When a risk factor, such as parental depression, domestic violence or poverty, is identified, we can provide help by connecting families to community resources.
So the next time your child’s doctor or provider asks about these sensitive issues, it is because we want to be able to help make sure your child thrives. We want to support you and your family. And what if your child’s doctor does not ask? If you feel comfortable bringing it up, please do. If a parent shares information that impacts the child or impacts the family — it will make them stop and listen.
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