Promoting self-understanding in parents--for the great good of your patients

Pediatricians are in a unique position to promote healthy parent-child relationships, and competent, confident parenting. Both the American Academy of Pediatrics (AAP) Guidelines for Health Supervision and the Bright Futures initiative stress the need to achieve strong childhood development. It is strong parenting that guides this developmental process. You now give to parents information about developmental milestones, changes in sleep patterns, setting limits and discipline, toilet training, mental stimulation, and age-appropriate play that helps them adopt suitable expectations for their child's development. Beyond information, parents need clear insight into the origins of their attitudes toward parenting to be able to deal effectively with their child's behavior. This article offers a framework for giving parents the right start, beginning with an understanding of their relationship with their parents, which portrays the deep reach of attachment in family life.

An icy plunge for new parents Adults who become parents are usually challenged by their new role, with its responsibilities and anxieties. New parents also face previously unexplored values and attitudes that surface suddenly upon the birth of their baby, as well as new routines and new problems that need an immediate answer. Such challenges often elicit a heightened emotional response, so that mundane matters suddenly make for excessive worry (who among us hasn't heard from the parents of an infant who hasn't had a bowel movement in two days?).

Other experiences quickly come, too, and add internal upset. The new mother is exhausted and feels-almost literally-consumed by her constantly hungry infant. The new father is dismayed at his wife's physical and emotional unavailability as she keeps her focus on the baby. Both must reset priorities of time, energy, and resources and balance home and work responsibilities. Both become aware that even more challenging child-rearing tasks and risks lie ahead: How will I protect my child from my own occasional frustrations, anger, and irritability? How can I avoid overindulging, yet set limits that are fair? How do I provide appropriate praise yet correct unwanted behavior? How do I allow my child time and space for play, yet teach cooperation and respect?

You, Doctor, can help!

One way that you can help parents, of course, is to provide child-development information and child-rearing strategies. Another is to guide them toward an understanding of their past-especially the relationship they had with their parents and how it influences their patterns of behavior today. Self-understanding for parents comes through a long process, in which they review their upbringing on their own and with their spouse or relatives, friends, and other parents and professionals.¹ Counseling skills aren't usually taught during medical training, but many experienced pediatric clinicians know how important these skills are in helping parents understand themselves and their long-term role.

Problems arise for parents when experiences, attitudes, and fears carried forward from their upbringing lead them to respond inconsistently or behave inappropriately toward their child.^2,3 When parents direct excessive anger, withdraw, use sarcasm and harsh criticism, or direct sharp orders toward their child, they upset, confuse, and, ultimately, damage that child. Once parents know the origins of their attitudes, however, they can learn to develop appropriate responses to their child. Reflection and self-exploration, inspired at opportune moments by your involvement, are key to change.