Ages and Stages: What Makes Toddlers Tick?

by Foster Cline, MD and Lisa C. Greene 

Charles Dickens wrote in A Tale of Two Cities: “It was the best of times and it was the worst of times...” The same could also be said about the toddler years! This is a time of discovery, wonder, unbridled joy, excitement about life, and unparalleled cuteness. This is also the time for stupendous tantrums, never-ending messes, demands, epic power struggles, and fits of all kinds. It all comes in the same, small package. 

Effective parenting skills are essential. The forming of self concept starts here and will impact self care and attitude throughout childhood and even into adulthood!. Many of the behavioral challenges when parenting adolescents are rooted in parenting responses during the early years. In fact, Jim Fay of Love and Logic says, “Teenagers are toddlers on hormones and wheels!”

When a child has a chronic illness like CF, the teen years are known as the “danger zone.” Poor self-care and rebellion is common, difficult to deal with, and when carried to an extreme, life-threatening. Wise parents start preparing for this well in advance of their child reaching puberty. And it all starts here- right after the first year of life.

Most mothers naturally handle tiny infants with "good enough" parenting. They are able to feed, cuddle, and change their baby. It is when toddlers develop their own curiosity about the world, want to explore it, and begin to develop a mind and intentions of their own that unaware parents start to lose the discipline and respect of their children. 

It is on the discipline issues in the second half of the first year and the first half of the second year that some parents begin to have real trouble. Depending on how they themselves were parented, they might be uncertain of how to effectively handle the terrible twos and troublesome threes. 

During this time, when discipline falters, children can become very difficult  and the parents soon grow weary. Adding the presence of CF compounds the problem. Food issues are common with all toddlers but can be particularly exasperating when a child has CF and is low on the growth chart. Without effective discipline, children are more likely to develop behavioral and emotional problems which have a direct impact on physical health and quality of life for the entire family. 

During the second year of life children must learn the foundation upon which all discipline is based which is Come, Sit, No, Go, Stay: “Come here.” Sit there.” “No.” “Go over there.” “Stay right here.”  When three-and four-year-old children respond (and it doesn't even have to be respectfully!) to "come, sit, no, go, and stay" parents are basically home free in the child's adolescence unless divorce, death, illness, or markedly poor parenting practices occur in the intervening years. And, most children who have had a good first two years of life are more easily reachable in therapy, regardless of their symptoms and behaviors. 

The fact that parents have the power and may use it is seldom openly discussed in parenting articles; even the words "parental power" is almost forbidden in today's politically correct climate. But let's look at this issue carefully. Children who have adequate parenting learn the following important life-lessons during the second year of life:
 

• Parents say what they mean and mean what they say
• Parents have the power
• Parents love them and would rather not use power
• Parents are willing to use power only when necessary

 Child development experts talk about the second year of life as the time of life that individuals learn "autonomy and independence." This is certainly true, but what experts sometimes neglect to say is that “response to authority” is the other side of the same coin. One can't have proper autonomy without learning proper response to authority. Every armed service teaches: “You can't give orders until you first learn to take orders." 

As children respond properly to parental structure and limits, parents give progressively more independence and freedom. When the child comes when called, he can play on the lawn. When the child learns not to run in the street, the child can play further from the immediate presence of the parent, etc. 

Having respect for authority is critical. Parents, teachers, and doctors are all important authority figures that will shape a child's life. Children who learn how to get along with authority figures will have a much easier time at home, in school, and in the medical system.  

As parents, we want to raise kids who see us as both powerful and loving. Most parents have the loving part down. It's the power they have trouble with. They tend to be either too hard or too easy on the child. So, how do parents effectively show infants and toddlers they have the power? Early on, it is physical responses carried without shows of anger and frustration:   

• They are carried to their crib
• They are lifted up and put down whether or not they like it
• They have their diapers changed no matter how they kick or arch their little backs
• When illness is present, they get their medications even when they resist
• When disobeying the command "Don't touch" parents remove the child's hand, remove the object or, if necessary, remove the child.

These responses are physical responses that say, "Honey, you have to do it my way, I have the power." And these responses must be delivered lovingly, calmly, and matter-of-factly: "Ohhh. I know you don't want a bath, sweetie, but that's not a choice. Here we go." And the parent gently dips the child in the bath and quickly washes him despite the fussing. Effective parents use loving action and few words rather than lots of words and no action.

Parents form the young child’s whole world and their children reflect the parent's emotions. Modeling is especially important so wise parents model the emotions and behaviors they want their children to show. When a parent is dealing with the stresses of life with medical issues, the emotions that parents model might not always be happy ones! Therefore, developing good stress management and coping skills is essential. We don't want our children to internalize our own unhappy, frustrated vibes. If we are upset, our child doesn't think: “Mommy is mad at the insurance company for denying a medical bill.” They think deep down inside, “Mommy is mad at me so I must be bad.”   

Using effective skills help parents reduce frustration and feel confident about handling the discipline challenges that are common with this stage of child development. When parents know how to avoid power struggles, set and enforce firm limits, and respond to misbehavior, life is happier for everyone in the short and long- term. 

Finding ways to take good care of yourself is especially important during these early years. It’s also the hardest because toddlers are time consuming and work intensive. The presence of medical issues makes it even more challenging. Getting support from others- family, friends and community- is critical. 

Toddlers and preschoolers learn about the world primarily through play, manipulative touch (like blocks), and pictures. They don’t learn by lectures and abstract concepts like “Take your medicine or you’ll get sick.” They are more likely to understand phrases like, “If you take your medicine before you eat, you’re tummy won’t hurt like it did yesterday. Would you like it with milk or juice?” 

Now is the time to start teaching your children about their bodies and begin laying the foundation of CF education that you'll build upon over the years to come. Start with simple picture books like Cadberry's Letters, Little Brave Ones, or Taking Cystic Fibrosis to School. Draw your own pictures together. We drew pictures of good knights (the medications) attacking the bad knights (the bacteria) to help both of our children understand, visualize, and have fun with, the reasons for inhaled medications. Be excited about the good choices your child makes. Show lots of emotion when things go well and very little emotion when they don't. 

Use creativity and fun to help young children comply with their medical requirements: play games, read books, make up fun songs, and be silly. Choices work especially well during these years. Parents should be using choices instead of demands and commands especially around medical treatments: "Would you like to do your breathing treatments now or in ten minutes?" "Would you like your pills with apple juice or grape juice?" "Would you like to color or play with stickers while you do your vest?" 

And, of course, these years are filled with so many No’s! Wise parents learn to re-word their phrases so they don't use the word 'No' too often. Example: Your kid says, "Can I have a cookie?" It's natural to say, "No. We're about to eat dinner." But you'll probably get an argument. Try this instead: "Sure! You may have a cookie right after dinner- which will be in ten minutes." 

Believe it or not, toddlers grow up! It may not seem like it at the time when they are so much work. But, they do grow up and start school. And this rite of passage brings a new batch of joys and challenges for parents to experience. You might even find yourself wistfully wishing for the days when they were little so enjoy them while you can... 

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Foster W. Cline, MD is a child psychiatrist and co-founder of Love and Logic^®. Lisa C. Greene is a parent educator and mom of two children with cystic fibrosis. Together they have written the award-winning book “Parenting Children with Health Issues."Visit  www.ParentingChildrenWithHealthIssues.com.

Copyright by Foster Cline, MD and Lisa Greene. All rights reserved.