Talking to children about death

http://www.cc.nih.gov/ccc/patient_education/pepubs/childeath.pdf

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Talk to your kids!

NY Times Story Here Nearly two decades ago, a landmark study found that by age 3, the children of wealthier professionals have heard words millions more times than those of less educated parents, giving them a distinct advantage in school and suggesting the need for increased investment in prekindergarten programs. Multimedia Tracking the Vocabulary Gap Enlarge This Image Ramin Rahimian for The New York Times Kara Glenister read from Megan Chu’s journal at a transitional kindergarten class at John Gomes Elementary in Fremont, Calif. Enlarge This Image Ramin Rahimian for The New York Times Ms. Glenister's class uses a new literacy program. Readers’ Comments "You will never be able to create a government program that compensates for poor parenting." Phil, Brentwood, TN Read Full Comment » Post a Comment » Now a follow-up study has found a language gap as early as 18 months, heightening the policy debate. The new research by Anne Fernald, a psychologist at Stanford University, which was published in Developmental Science this year, showed that at 18 months children from wealthier homes could identify pictures of simple words they knew — “dog” or “ball” — much faster than children from low-income families. By age 2, the study found, affluent children had learned 30 percent more words in the intervening months than the children from low-income homes. The new findings, although based on a small sample, reinforced the earlier research showing that because professional parents speak so much more to their children, the children hear 30 million more words by age 3 than children from low-income households, early literacy experts, preschool directors and pediatricians said. In the new study, the children of affluent households came from communities where the median income per capita was $69,000; the low-income children came from communities with a median income per capita of $23,900. Since oral language and vocabulary are so connected to reading comprehension, the most disadvantaged children face increased challenges once they enter school and start learning to read. “That gap just gets bigger and bigger,” said Kris Perry, executive director of the First Five Years Fund, an advocate of early education for low-income children. “That gap is very real and very hard to undo.” President Obama has called for the federal government to match state money to provide preschool for all 4-year-olds from low- and moderate-income families, a proposal in the budget that Congress voted to postpone negotiating until later this year. The administration is also offering state grants through its Race to the Top Program to support early childhood education. Critics argue, however, that with so few programs offering high-quality instruction, expanding the system will prove a waste of money and that the limited funds should be reserved for elementary and secondary education. But at a time when a majority of public schoolchildren in about a third of the states come from low-income families, according to the Southern Education Foundation, those who are pushing for higher preschool enrollment say that investing in the youngest children could save public spending later on. In the latest data available from the National Institute for Early Education Research at Rutgers University, 28 percent of all 4-year-olds in the United States were enrolled in state-financed preschool in the 2010-11 school year, and just 4 percent of 3-year-olds. The National Governors Association, in a report this month calling on states to ensure that all children can read proficiently by third grade, urges lawmakers to increase access to high-quality child care and prekindergarten classes and to invest in programs for children from birth through age 5. In New York, the Democratic mayoral candidate Bill de Blasio has said he would tax high-income earners to pay for universal prekindergarten in the city. “A lot of states are saying, ‘Let’s get to the early care providers and get more of them having kids come into kindergarten ready,’ ” said Richard Laine, director of education for the National Governors Association. That way, he said, “we’re not waiting until third grade and saying, ‘Oh my gosh, we have so many kids overwhelming our remediation system.’ ” Currently, 17 states and the District of Columbia have policies requiring that third graders be held back if they do not meet state reading proficiency standards, according to the Education Commission of the States. Now, with the advent of the Common Core, a set of rigorous reading and math standards for students in kindergarten through 12th grade that has been adopted by 45 states and the District of Columbia, educators say the pressure to prepare young children is growing more intense. Literacy experts have previously documented a connection between a child’s early vocabulary and later success in reading comprehension. In a study tracking children from age 3 through middle school, David Dickinson, now a professor of education at Vanderbilt University, and Catherine Snow, an education professor at Harvard University, found that a child’s score on a vocabulary test in kindergarten could predict reading comprehension scores in later grades. Mr. Dickinson said he feared that some preschool teachers or parents might extract the message about the importance of vocabulary and pervert it. “The worst thing that could come out of all this interest in vocabulary,” he said, “is flash cards with pictures making kids memorize a thousand words.” Instead, literacy experts emphasize the importance of natural conversations with children, asking questions while reading books, and helping children identify words during playtime. Even these simple principles may be hard to implement, some educators say, because preschool instructors are often paid far less than public schoolteachers and receive scant training. In one study, Robert Pianta, dean of the Curry School of Education at the University of Virginia, found that in observations of 700 preschool classrooms across 11 states, teachers in less than 15 percent of the classes demonstrated “effective teacher-student interactions.” “There is a lot of wishful thinking about how easy it is, that if you just put kids in any kind of program that this will just happen,” said W. Steven Barnett, director of the National Institute for Early Education Research, referring to the development of strong vocabularies and other preliteracy skills. Literacy experts and publishing companies are rushing to develop materials for teachers. Scholastic Inc., the children’s book publisher, for example, began selling the Big Day for Pre-K program to preschools three years ago. Collections of books come with specific question prompts like “I see a yellow taxi. What do you see?” Educators and policy makers say they also must focus increasingly on parents. In Vallejo, Calif., where about 400 children up to age 5 attend publicly funded prekindergarten programs, the district invited Anne E. Cunningham, a psychologist and literacy specialist from the University of California, Berkeley, to conduct a training program for preschool teachers that included the development of parent education workshops. And in Kentucky, the governor’s Office of Early Childhood started a social media campaign last year that offers simple tips for parents like “Talk about the weather with your child. Is it sunny or cloudy? Hot or cold?” Middle class and more-affluent parents have long known that describing fruit at the supermarket or pointing out the shape of a stop sign are all part of a young child’s literacy education. But even in low-income families, parents who speak to their children more frequently can enhance vocabulary. In separate research, Ms. Fernald, working with Adriana Weisleder, a graduate student in psychology, recorded all the words that 29 children from low-income households heard over a day. The researchers differentiated between words overheard from television and adult conversations and those directed at the children. They found that some of the children, who were 19 months at the time, heard as few as 670 “child-directed” words in one day, compared with others in the group who heard as many as 12,000. Those who had heard more words were able to understand words more quickly and had larger vocabularies by age 2. “Even in families that are low income and perhaps don’t have a lot of education, there are some parents that are very engaged verbally with their kids,” said Ms. Weisleder. “And those kids are doing better in language development.” This article has been revised to reflect the following correction: Correction: October 22, 2013 An earlier version of this article referred incorrectly to the scope of the incomes of the families who were part of the new study. The cited income — $69,000 from affluent households; $23,900 from low-income homes — was the median income per capita, not the median income.

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Empathy in Teens, boys vs. girls: from WSJ

Teens Are Still Developing Empathy Skills Vital Social Skill Ebbs and Flows in Adolescent Boys; How to Cultivate Sensitivity By SUE SHELLENBARGER New research shows that biology, not parenting, is to blame for insensitive and selfish behavior by teenagers. But, there can be ways to teach teens empathy. Sue Shellenbarger and "Masterminds and Wingmen" author Rosalind Wiseman join Lunch Break. Photo: AP. The teen years are often fraught with door-slamming, eye-rolling and seeming insensitivity, even by kids who behaved kindly before. Some parents worry that they're doing something wrong, or that their children will never think of anyone but themselves. New research shows that biology, not parenting, is to blame. In adolescence, critical social skills that are needed to feel concern for other people and understand how they think are undergoing major changes. Adolescence has long been known as prime time for developing cognitive skills for self-control, or executive function. "Cognitive empathy," or the mental ability to take others' perspective, begins rising steadily in girls at age 13, according to a six-year study published recently in Developmental Psychology. But boys don't begin until age 15 to show gains in perspective-taking, which helps in problem-solving and avoiding conflict. Adolescent males actually show a temporary decline, between ages 13 and 16, in a related skill—affective empathy, or the ability to recognize and respond to others' feelings, according to the study, co-authored by Jolien van der Graaff, a doctoral candidate in the Research Centre Adolescent Development at Utrecht University in the Netherlands. Fortunately, the boys' sensitivity recovers in the late teens. Girls' affective empathy remains relatively high and stable through adolescence. The riptides are often noticeable to parents. Susan Burkinshaw has tried to cultivate empathy in her two teenage sons, 16 and 18, since they were toddlers, encouraging them to think about others' feelings. Yet one "went through a period in eighth grade where he was just a bear to deal with. He always had an attitude," says Ms. Burkinshaw, of Germantown, Md. "Then as quickly as it came on, it turned back off again." The findings reflect a major expansion in researchers' understanding of cognitive growth during adolescence, according to a 2012 research review co-authored by Ronald Dahl, a professor of public health at the University of California at Berkeley. Researchers used to believe that both forms of empathy were fully formed during childhood. Now, it's clear that "the brain regions that support social cognition, which helps us understand and interact with others successfully, continue to change dramatically" in the teens, says Jennifer Pfeifer, an assistant professor of psychology at the University of Oregon in Eugene. Preliminary research in her lab also suggests cognitive empathy rises in teens. The discoveries serve as a new lens for exploring such teen behaviors as bullying and drug abuse. Kids who develop affective and cognitive empathy form healthy relationships and argue less with their parents, research shows. Perspective-taking continues to be central for adults on the job, helping in designing and selling products and services, building user-friendly devices, and working smoothly with others with diverse viewpoints and backgrounds. Affective empathy is grounded in the limbic region of the brain, which regulates emotions. This capacity begins developing in infancy when parents respond sensitively to babies' emotions. Children learn to practice empathy by watching their parents and by experiencing it themselves—being treated well by adults who respond warmly to their feelings, says Anthony Wolf, a Longmeadow, Mass., psychologist, author and speaker. Cognitive empathy arises from a different part of the brain, the medial prefrontal cortex, which continues developing later, through adolescence. But the two are linked; children's affective empathy predicts their level of cognitive empathy as teens, says a forthcoming study by Caspar Van Lissa, a doctoral candidate at Utrecht's adolescent-research center. Parents can help instill affective empathy by encouraging children to walk in others' shoes. If Ms. Burkinshaw's kids saw a child being teased or treated badly, she asked them, "If that had been you, what would you have wanted your friends to do to help?" Her 12-year-old daughter Alexandra recently told her that several classmates had hurt another girl's feelings by blocking her from following them on Instagram. "I said, 'What could you do to help her?' " Ms. Burkinshaw says. Alexandra talked with her friends, and another mother also intervened. The girls apologized and invited the victim back into the group. Adolescents' brains work particularly hard on perspective-taking; teens make heavier use than adults of the medial prefrontal cortex, says Sarah-Jayne Blakemore, a professor of cognitive neuroscience at University College London. That may be because understanding others' viewpoints takes more conscious effort for teens, while it becomes automatic for adults, Dr. Blakemore says. Perspective-taking continues to develop through age 21. The decline in affective empathy among young teenage boys may spring at least partly from a spurt during puberty in testosterone, sparking a desire for dominance and power, says the study in Developmental Psychology. Boys who were more mature physically showed less empathy than others. Boys also feel pressure from peers and some adults to "act like a man," which they often define as being detached, tough, funny and strong, says Rosalind Wiseman, Boulder, Colo., author of "Masterminds and Wingmen," a new book about teen boys. They may suppress feelings of empathy so they can join in joking and teasing with peers, she says. "Humor is the social glue among boys, and empathy would be a brake on what they can and cannot joke about." So some kids "stop listening to their gut." Also, some teens may appear insensitive because they're actually struggling to avoid being overwhelmed by their own feelings of empathy, says Brad Sachs, Columbia, Md., a psychologist, author and speaker. "Teens who seem aloof, hard-hearted or unkind may in reality be quite the opposite." Fathers seem to play a special role. Teens whose fathers are supportive, who say they feel better after talking over their worries with their dads, are more skilled at perspective-taking, says a 2011 study of 15- to 18-year-old boys in Developmental Psychology. Yu Oen of Princeton Junction, N.J., encourages his sons Grant, 19, and Sean, 15, to take others' perspective by discussing current events with them—including how the people involved must have felt. After the Boston Marathon bombing, they talked about how a runner who lost her legs must have felt when entering a restaurant where everyone else was wearing shorts. "You can see their reaction: 'Wow, that is really tough,' " Mr. Oen says. "They feel it: 'What if that had been me?' " Mr. Oen and his wife Shirley "feel it too," he says. "And we take time to talk about these things." Write to Sue Shellenbarger at sue.shellenbarger@wsj.com

Beyond Baby Weight: from WSJ

Bigger Postpartum Challenges Than Just Baby Weight Pregnancy Can Put Significant Strain on Muscles and Bones Sarah Nassauer connect Oct. 14, 2013 7:26 p.m. ET Having a baby leaves a woman's body off kilter in various ways that are often overlooked. Sarah Nassauer and physical therapist Marianne Ryan join Lunch Break with a look at what women should (and shouldn't) be doing. Photo: AP. The issue of baby weight hangs heavy on the minds of many postpartum women, with images of famous moms like the impossibly fit model Gisele Bündchen, who had her second child last year, seared into their brains. But more women and health professionals are turning their attention to changes beyond weight. Pregnancy and labor cause significant strain on muscle and bone structures. Some research shows that stretched, weakened or torn muscles and misaligned bones may seem simply annoying at first, but can develop into debilitating disorders years or decades later. More women in the U.S. are having babies older and in some cases spacing pregnancies closer together, giving the body less time to recover. There has also been an increase in fertility treatments such as in vitro fertilization, which lead to more twin pregnancies that add to the physical strain on women's bodies. "It's a massive physical challenge" to have a baby, says Jessica McKinney, director of the Center for Pelvic and Women's Health at Marathon Physical Therapy and Sports Medicine based in Boston. Abdominal muscles lengthen significantly during pregnancy, the spine moves into an exaggerated S curve, caesarean section can leave internal scar tissue, and the hammock of muscles in the pelvis that support organs and bones, called the pelvic floor, stretches or even tears, she says. Before and After Baby View Slideshow Physical therapist Jessica McKinney worked with co-worker Kyla Triveri, who is seven months pregnant. Christopher Churchill for The Wall Street Journal Left untreated, the changes can cause problems down the road, from pelvic and low back pain to incontinence and other issues. Courtney Freck, an avid runner who lives in Sterling, Va., started having sharp hip and back pain while running about a year after the c-section birth of her second daughter. Doctors weren't sure what was wrong. Eventually, she consulted a women's health physical therapist who pointed to her weak core muscles and her lingering diastasis recti, or the separation of her "six-pack" muscles. The separation occurs in almost all pregnancies and often doesn't resolve on its own. "I just thought it was one of those things, you have a baby and things never go back," says the 36-year-old purchasing manager for a health-care company. She did exercises to strengthen her interior abdominal muscles and pelvic floor. She is now training for a marathon, running about 25 miles a week. Enlarge Image To reduce diastasis recti during pregnancy, physical therapists recommend avoiding sit-up movements that rely on the external abdominal muscles. Instead, they suggest women get out of bed by lying on their sides and pushing themselves up with their arms. With a new baby to care for, women often ignore seemingly small things like pain, says Ms. McKinney of Marathon Physical Therapy. Patients think "I have to throw myself at the altar of motherhood," and it's normal that my body doesn't work as well, she says. To explain why so many of their patients don't seek treatment until years after they gave birth, many health professionals that focus on musculoskeletal issues during and after pregnancy tell a similar tale. "I will hear, 'After my first pregnancy I occasionally leaked as I coughed' " or I had some pain, but I didn't see it as a problem, says Secili Destefano, a physical therapist and director of research for the American Physical Therapy Association Section on Women's Health. Then a woman ages, her muscles start to deteriorate and her hormone levels change. "And now your body is doing things you don't want it to," she says, and finally you go to a doctor. If a woman seeks help earlier "we can use simpler treatments," such as physical therapy in lieu of surgery to repair a weakened pelvic floor or pelvic organ prolapse, says Linda Brubaker, an urogynecologist and dean of the Stritch School of Medicine at Loyola University Chicago. Dr. Brubaker recommends every woman ask her doctor or nurse to check her pelvic floor strength at the 4-to-6-week postpartum checkup. The pelvic floor is "the center of the universe," because it supports so many organs and bones, she says. Even c-section scarring can be treated to prevent pain. Any internal scar can adhere to other parts of the body while healing, hampering muscle movement or causing pain years later, says Debra Goodman, a physical therapist in Albany, N.Y. She massages scar tissue once it has healed to keep skin and tissue mobile, she says, noting improvement can happen "even 20 years later." About 30% of births happen via c-section in the U.S. Women are regularly told by doctors to do Kegel exercises to strengthen the pelvic floor during or after pregnancy, but many women do them incorrectly, pushing out instead of up and in or contracting the wrong muscles, says Colleen Fitzgerald, medical director of the Chronic Pelvic Pain Program at Loyola University Chicago. Many of these issues get little attention among women and some obstetricians for a complex web of reasons. A spokesman for the American Congress of Obstetricians and Gynecologists says there is a "tremendous amount of information that must be conveyed" at a postpartum visit and that doctors refer patients to specialists when they find problems with the pelvic floor. Obstetricians rely on prenatal classes to train patients in Kegel exercises, he said. Exercising too hard too soon can lead to problems including pelvic pain, say some doctors and physical therapists. Women can exercise as they normally would during pregnancy and after their 4-to-6-week postpartum checkup as long as they don't have pain, say most health professionals. If a postpartum woman has weak core muscles or a large diastasis recti, running or other pounding exercises can be problematic. Hold off until you know you have stable core strength, says Marianne Ryan, owner of MRPT Physical Therapy in New York City. However, women can start doing pelvic floor and breathing exercises in the days following labor if it doesn't cause pain, says Ms. Ryan. Symptoms that are often linked to unresolved injuries during childbirth are common in the U.S., especially as women age. Almost 40% of women 60 to 79 years old report symptoms of some type of pelvic floor disorder, which includes incontinence and pelvic organ prolapse, when organs press against or descend into the vaginal walls causing a sensation of pressure, according to a 2008 study from the Journal of the American Medical Association. In the study, the more children a woman gave birth to the more likely she was to have symptoms. Overall about 24% of U.S. women who aren't currently pregnant had such symptoms, according to the study that reviewed medical data for 1961 women 20 and older. Obesity was also a risk factor. Some research shows these numbers are likely to increase in the coming decades as the population ages. "I felt really accomplished that I had good pregnancies," says Karen Ivas, a 56-year-old Mansfield, Mass., resident and mother of five. "A week after I delivered I was in my jeans." But in her early 50s she started to experience minor incontinence issues. "I didn't think too much of it," says Ms. Ivas, until she realized she couldn't live "without having to worry about where the next bathroom was." One doctor she consulted said, "Oh that's the way it is. A lot of people have your problem," she says. She had surgery to lift her uterus and other repairs, but it didn't resolve her problem, she says. More recently she has found some relief from regular trips to a women's health physical therapist, doing hands-on therapy and other exercises. "I had more than one OB and nobody ever said anything to me about pelvic health," she says. Write to Sarah Nassauer at sarah.nassauer@wsj.com

Parenting exercise "my mother always, my father never"

From yahoo discussion board: "We had to to do a parenting exercise which involved making two lists each. One entitled "my father never..." "my father always.." and the other "my mother never..." "my mother always..." we had to write down what our parents were like & the good and bad qualities they possessed. When we were done, We talked about what we wrote down and decided together which behaviors we value and which we'd like to change as we raise our child. Which qualities and behaviours did you decide to use and not use for your child & how do you differ from your parents' raising methods?"

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Super Nanny Tips

1. Thought box for kids... setup a box with a slot. Allow children to put their ideas and thoughts down on paper, then put it in the box. Parents can later review the thoughts and talk about it with their children. Encourages openness and eliminates barriers on topics that are more difficult to discuss.

2. Mommy & Me time... setup time that is specifically mommy and me or daddy and me. That way each parent has dedicated, scheduled one-on-one time with the baby

3. Engagement... keep the children engaged. If you are doing an activity like picking pumpkins, add some type of analysis to the project, for example... who can find a pumpkin that is 24" round, and give them a tape measure, or count the number of ridges in the pumpkin, or list all of the colors that you see. It gives children more things to think about than just simply picking the pumpkin. Another example, jenga, ask them intriguing questions, i.e. do you think that if I pull this stick, the whole wall will fall?

4. Undermine... it's important to keep a unified front. As parents, if you are seen as one solid front, then children will not be able to play one parent off of the other and gain some form of control. Instead, parents should support each others comments and decisions in front of the children, then resolve disputes privately.