Attachment and Bonding with Adopted Toddlers and Preschoolers

When many people think of adoption, the story that comes to mind is that of a waiting hopeful adoptive couple who get “the call” from their agency that an expectant mother has chosen them to parent her newborn child. The couple rushes to the hospital to pick up their brand-new-to-the-world infant son or daughter. The baby is placed in their arms and the family is bonded almost instantaneously.

While this stereotypical scenario does happen for some adoptive families, other adoptive families might instead experience “the call” from a social worker about a foster child needing placement, an international adoption agency letting a family know they will be flying to another country soon to pick up their child, or a domestic agency letting a family know there is a toddler or preschooler (or older child) available for adoption. When the child arrives—whether they are 16 months, 2 years old, or 3 ½ years old—they are old enough to have memories of other families or other living circumstances. The adults they lived with may not have been safe or may have behaved unpredictably. Multiple changes in where they have known “home” to be and who their caregiver has been can cause a fair amount of stress and confusion when they come home to the adoptive family.

Given these possibilities, attachment and bonding strategies (particularly early on) are essential for supporting kids in helping them feel safe and connected to their new parents, and in turn the parents connected to their new child. When kids feel safe and have certainty that their needs are important and will be met, their feelings of connection to their parent(s) grows.

Here are some ideas to get started with bonding and attachment:

• Establish a family routine. The more predictable the environment, the more likely your child will feel comfortable in it. Some families will use calendars or laminated flip cards with pictures showing what is coming up each day (e.g., preschool, pediatrician visit, play date, spending time with other family members, holidays, etc.) to guide conversations about what will be happening as they get ready in the morning. As adults, we appreciate knowing what is happening for the day; kids are no different.
• Touch and smell are important first steps to bonding. Find a lightly scented lotion (e.g., vanilla, citrus, lavender, etc.). While kiddo is sitting on your lap or next to you, gently massage the lotion into both your hands and allow them to rub it on your hands, too, as they feel comfortable. Comment about how good the lotion smells, and how you both smell the same. This activity gives the opportunity for close proximity, eye-to-eye and skin-to-skin contact, and gentle loving touch.
• Soft blankets or loveys. Find the softest blanket or lovey possible then buy at least two that are exactly alike. These soft special items can be part of snuggling as kiddo and parent get ready for nap or bedtime, can provide comfort when little one is upset, and can also be a familiar security item when the child is away from Mom and Dad for short periods of time. Buying at least two that are identical is both a parental sanity saver and gives you a backup in case one gets lost, wet, left at Grandma’s house, or otherwise. Rotate and wash them both with similar regularity so they both look and feel the same.
• Put up family pictures around your home. Many children who come to their families through adoption were where there were not pictures of the child displayed. Pictures of your family together is another visible sign that we belong together.
• Baby wearing. Even with toddlers and preschoolers, you ask? Yes! There are a few companies that make baby carriers designed to carry kids up to 45 lbs. if you are so inclined. The ergonomic styling makes it comfortable to wear with your little one, and allows for lots of face-to-face time. It can also make it much easier for airline travel: kiddo in the carrier in the front, carry-on backpack on the back, and away you go.
• Play! It doesn’t always come naturally to adults to get down on the floor to play with toys, but wow does it do a lot for connection! Our kids love knowing their parents see what they are interested in is important, too. If it’s a difficult transition for you (you won’t be the first grown up to feel this way), try doing it for a few minutes at a time, increasing the amount of time with each interaction. Before you know it, you might just find that you love building Thomas the Train tracks, too (or at least loving being a part of the process with your child).
• Include your child in family activities. Kids in the toddler and preschool years are often very enthusiastic about being helpers. It’s great training for them continuing the habit as they grow and provides an excellent opportunity for saving video of your child demanding to do thing like washing the dishes. 😊
• Provide front-loading for transitions. In the history of our children who were adopted as toddlers or preschoolers, change often came without warning and, in many cases, wasn’t positive. This can make sudden transitions between activities or locations very fear producing for you kiddo, even months or years after they have come to live in the safety of your family. One way to reduce this response is by doing what I call “front-loading”: giving kids advance notice before the change happens. For instance, if you are getting ready to leave in the morning and your little one is happily playing with their toys, you might let them know at 20 minutes prior that they have some time to keep playing but that you will be leaving for preschool in a little while. Another reminder comes at 10 minutes, and at 5 minutes you help them start picking up their things. The more they can feel a part of and understanding what is happening, the more their perceived safety increases and the more they can feel connected to you.

Further information on bonding and attachment, check out these resources:

• The Connected Child by Karyn Purvis and David Cross
• I Love You Rituals by Becky Bailey
• The Whole Brain Child by Daniel Siegel and Tina Payne Bryson

– Gretchyn Edwards is a student intern with the Parenting Program while she is completing her master’s in social work at Michigan State University. She and her husband are proud parents by way of adoption to their son, Julian.

Pizza Love

Scott Bauer, Wikimedia Commons

What is usually round, cut into triangles and served in a square box?

Pizza!

This extremely popular food has been defined as: “The perfect meal. An open-faced pie using tomato sauce, cheese and any manner of toppings. Tastes like heaven and is sometimes stated to be better than a relationship.”

But pizza is more than sauce, cheese and toppings. For crust options alone we see hand-tossed, crispy crust, New York thin crust, Chicago deep dish, Detroit-style square, and more. Add in a wide range of sauce options and toppings and the possibilities are seemingly endless!

While the Parenting Program staff has our individual favorites, we all agree that we love pizza! Our staff also made note that there is a difference between sit-down places and take-out. Here is our take on our favorite pizzas in metro Detroit.

Delivery/take-out

• Emily Swan: Jet’s Pizza is our family’s favorite carryout pizza, hands down. The Detroit-style square pizza with the crispy crust is sooooo good! We love their breadsticks and their buttermilk ranch dressing is top-notch. I recently learned that you can buy a bottle of their ranch to keep at home! My kids know when we’re trying to pull a fast one and give them Hidden Valley Ranch instead of Jet’s, my then-two-year-old once insisted on “pizza ranch”!
• Deanna Robb: My kids love Jet’s but my husband and I prefer Green Lantern.
• Lori Polakowski: We make pizza at home. My favorite is white pizza with caramelized onions, pine nuts, arugula, mushrooms and mozzarella.
• Lucy Hill: Our favorite take-out is Green Lantern.
• Karen Duffy:Our favorite is Jet’s.
• Nicole Capozello: My favorite place for pizza is home, straight out of my own oven, using the deep dish pan my mom bought me in Chicago. However if it’s from someone else is oven, we like carryout from Holiday Pizza in Sterling Heights.
• Becky Bibbs: My family loves Marco’s Pizza for carry-out. The sauce is delicious and the hand-tossed crust is always baked perfectly. Bonus: When you pick up your pizza, they open it and check it over with you to make sure it’s what you ordered. (They make great subs, too!)
• Stephanie Babcock: Our favorite order-out pizza is Hungry Howie’s. My boys like trying different flavor crusts every time we order.

Sit-down

• Emily Swan: Our favorite sit-down place is Loui’s Pizza in Hazel Park.  This place is not fancy and they don’t take reservations.  Be prepared to stand in line on the weekends!  Their Detroit-style pizza is delicious, but our favorite thing on the menu is their antipasto salad!  You can buy their Italian dressing to take home.  It’s delicious – I think I could drink it!
• Deanna Robb: We rotate between Bigalora Wood Fired Cucina, Crispelli’s, and of course, Alibi of Troy. But my go-to pizza is the Pesto Genovese pizza and crispy Brussels sprouts (small plates side) at Bigalora. Yum!!!
• Lucy Hill: We do not eat pizza out much but if we do, Loui’s Pizza is the one!
• Nicole Capozello: For dine-in, it’s got to be UNO Pizzeria & Grill’s Chicago-style pizza (chunky sauce, please!). 
• Becky Bibbs: MOD Pizza is amazing! We love that we can each order own individual, thin-crust pizza just the way we want. Whether you put on one topping or all of the 30+ options, the price doesn’t change. Still hungry? Order a crème-filled, chocolate “no-name cake” for dessert.
• Stephanie Babcock: Our favorite sit-down pizza is California Pizza Kitchen. My family likes the BBQ chicken pizza and a good old-fashioned pepperoni pizza. I think they enjoy the different tastes of having BBQ sauce as the base. The latest hit for the boys is enjoying ranch dressing as a dipping sauce for pizza. What is that about?!

Are any of these your top pizza places? Do you have a favorite place you think we should try? Let us know in the comments.

Screen-Free Valentine’s Fun

Bill Branson, Wikimedia Commons

In today’s modern world, there is no better gift for your family than your presence. So this Valentine’s Day, think outside the box to spend some screen-free time with the ones you love. The American Academy of Pediatrics recommends no screen time before age two and less than two hours a day for kids older than two. There are many screen-free activities that kids can engage in by themselves or while bonding with their family or friends. And even better, screen-free activities are great for fine and large motor skill development as well as developing creativity and imagination. Read on to find some suggestions for screen-free activities for preschoolers and elementary-age kids.

• Puzzles
• Reading
• Have a dance party
• Have a tea party
• Paper dolls
• Make music using common household objects
• Building
  • Blocks
  • LEGO/Duplo
  • Magna-Tiles or similar
• Board games
  • Candy Land is a great beginner game. My kids all began enjoying it around age 3.
  • Card games like Go Fish and UNO are great for elementary-age kids.
• Crafts
  • Highlights^TM magazine has some great ideas that can be found in print or online.
  • Boxes and recycled materials have endless craft possibilities.
• Sensory activities
  • Paint in a zip-top bag is fun for drawing letters or shapes in.
  • Kinetic sand, cotton balls, and anything with texture
  • Play-Doh (homemade or store-bought)
• Play outside
  • Nature scavenger hunts and collecting nature for art are some favorites in my house.
  • Check out a new park.
• Cook/bake together
  • We are big on food traditions in my house and “Cookie Fridays” are high on my list of screen-free favorites.
• Take a fieldtrip
  • My kids are always happy to check out a new place and the library is one of our favorite go-to places.

Consider making this Valentine’s Day screen-free and enjoy some extra snuggles while you can!

– Melissa Rettmann, M.S., PA-C, has a background in pediatrics and allergy. She is the mother of three young children and volunteers with the Parenting Program.

Bedwetting: When to Worry, What to Do

Mostafameraji, wikimediacommons

Bedwetting, also known as nocturnal enuresis, is often asked about in whispers, as an aside, or in the hallway away from the child. Embarrassment is the concern of course, but bedwetting is common and a normal part of growing up for many children. I tend to shed light on the subject with the child present to normalize the issue and help them see that there is nothing to be ashamed of.

Children potty train between the ages of 18 months and 4 years. Whether your child is an early or later potty trainer, nighttime dryness may come immediately or follow after some weeks, months or even years. Over 80% of children are dry at night soon after daytime training though and the issue of bedwetting is resolved by age four, but even older kids who are later to train may not have anything wrong with them.

Most of the time bedwetting is normal. Sixteen percent of kindergarteners, 10% of fifth graders, and even 1% of high school freshmen, will wet the bed at least one night of the week. Even though bedwetting is common, it is occasionally a sign of a more serious medical issue. For this reason, it’s important to see your pediatrician to discuss bedwetting.

Here are a few clues that your child’s problem could indicate something more serious is going on:

• She drinks a lot of fluid, especially if she gets up at night to drink.
• She eats a lot of food but isn’t gaining weight.
• He has lost several pounds recently without trying.
• He is having daytime accidents too.
• She reports pain with urination.
• He is going to the bathroom a lot more frequently during the day.
• She seems very anxious all of a sudden.
• He reports that he is afraid to go to school (or another specific location).
• Bedwetting or daytime wetting is very new. He used to be dry at night for a long time and now is having trouble.
• He is having hard or infrequent poops.
• She snores like a freight train.

Assuming your child potty trained at the usual time and has had bedwetting ever since, without regular daytime symptoms, the following bedwetting FAQs are for you!

My 7-year-old wets the bed every night. His 4-year-old brother is already dry all night! Is he just being lazy?

Bedwetting isn’t due to laziness. Kids aren’t choosing to wet the bed, staying in bed when they feel the urge to go instead of getting up. They are legitimately not wired yet in a way to feel the urge when they are asleep. Everyone develops at different rates and your 7-year old’s nervous system isn’t ready yet even though your younger child’s is.

Should I get my child up and take her to the bathroom when I go to bed? Will that help her stay dry all night?

It may help her stay dry, but it won’t help her learn to feel the urge to go to the bathroom when her bladder feels full. Data suggests that children who are awoken by parents don’t achieve night dryness earlier. The recommendation is not to do this.

When can I expect my child to outgrow this?

If you have a family history of bedwetting in any relative, the age at which they outgrew it is often a good estimate of when your child will outgrow it too. If not, you will start to see the frequency decrease as your child outgrows it.

What can I do to help my son train at night before trying a bed alarm?

Sugar, caffeine and fluids can all play a role. So can behavior modification strategies. When you feel your son is old enough to be motivated to work on this issue do the following:

1. Put a protective covering on his mattress and a spare set of sheets near the bed at night.
2. Adjust his fluid intake so he overall takes less and the amount is divided as such: 40% from 7 a.m. to Noon, 40% from Noon to 5 p.m., and only 20% after 5 p.m. For a child drinking 20 ounces per day, that works out to 8, 8, and 4 ounces. Or 9, 9, and 5 if taking 24 ounces per day.
3. No caffeine or sugar after 5 p.m. during the training phase because they increase urine output.
4. Urinate at least four times between 5 p.m. and bedtime, going twice in the half hour before bed.
5. Wear underwear to bed.
6. Have the child responsible for changing PJs and sheets at night. (You can assist a bit but mostly his job.)
7. Earn stars/rewards for waking at night if any pee in the toilet or to change the sheets at first.

How long does the training take?

Give the above training three or four weeks and if you haven’t made progress, set it aside for a while.

What about bed alarms?

Bed alarms are very effective at reducing bedwetting and are most successful in children 8 and older. Bed alarms have a sensor that detects moisture and awakens the child through either loud noise or vibration. It often needs to awaken the parent too at first since children are often deep sleepers. Like the strategy above, the child wears underwear, gets rewards, and changes sheets, but is stirred awake when wetness starts. This encourages an association between that wetness and the need to wake up. Bed alarms are the best next step when the first approach doesn’t work.

I’ve heard about medications for bed wetting too. Can’t I just use those?

Desmopressin is a good choice sometimes. It is a medicine that essentially tells the kidney to make dramatically less urine for the night. Although it can be used long term, because it effects the kidney itself and bedwetting in most cases is not due to a medical issue, I tend to only recommend this for things like sleepovers or camp. Don’t plan to come in the day before camp have your appointment to get the prescription. This medication doesn’t always work! It’s best to do a trial run long before camp and make sure your child responds well.

Can I address bedwetting at my usual wellness visit?

I recommend a separate appointment for this issue. We usually need a urine sample along with a more detailed history. When it’s simple, straightforward bedwetting it’s easy, but if it isn’t straightforward, we won’t have the time needed to talk about that along with the other important issues at the wellness visit.

What causes bedwetting?

I left this one for last because it is the hardest to answer. The best answer is probably that the nervous system is still immature. As a result, sleep cycles are a little off causing difficulty in sensing the urge to urinate during the night. As the brain matures and sleep cycles regulate, night dryness resolves.

– Dr. Molly O’Shea, a board-certified Beaumont pediatrician, offers traditional medicine in non-traditional ways including newborn home visits and emailing parents directly. She has practiced pediatrics for nearly 30 years and was the “Ask the Pediatrician” columnist for the Detroit News for many years. A journal editor for the American Academy of Pediatrics, she also organized the AAP’s national continuing education programming for pediatricians. Dr. Molly loves cooking, traveling and spending time with her family.

My Momcation

I took a glassblowing class during my recent momcation.

I’ve been a mom for eight wonderful, amazing, exhausting, frustrating years. In those years, aside from overnight sleepovers, I had been away from my kids for about six days total, in three increments.

I was due for a vacation.

When my sister-in-law asked if I wanted to mooch on her work trip to Seattle, I jumped on it. Luckily for me, my husband did, too. He recognized I hadn’t had a break in a while and knew that it would be important for my mental health to leave the nest and recharge.

Right about the time I booked my flight, I expected the mom guilt to settle in. But you know what? It didn’t. I was too excited researching my trip. I had Monday through Saturday to do whatever I wanted. I only had to find my own shoes! I could eat at different restaurants that didn’t serve grilled cheese! I could just sit and read if I wanted. Or drink my tea in peace.

Honestly, I didn’t let myself feel guilty about the kids on this one. I felt a tad guilty about leaving my husband by himself with our punks, which he’d never done before, but I got over that pretty fast, too.

See, I’ve reached a point where I know that taking care of myself is important, too. Going out with friends, volunteering and freelance writing are all things that make me happy and healthy. So, I do them free of mental burden. I wish I’d gotten to this point sooner.

I thought that to be a good mom, I had to lose myself in motherhood. That I had to revolve my life around my kids. To an extent part of that will always be true, but not in the eclipsing way where parents become completely absorbed.

This getaway was just what I needed. It recharged me and gave me new energy. When was the last time you got away from it all? I’m not talking about a solo trip to Target or a bath with wine. I’m talking about silence. Dinner with cloth napkins. Non-animated shows. Uninterrupted showers.

You deserve it. It’s not selfish. It’s important. And so are you.

– Rebecca Calappi is a freelance writer, adoptive mom to twins, and past Parenting Program participant. Surprisingly, she’s mostly sane.