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Parents often complain about their children:
“I tell him: “Get your toys.” He plays as he played. I told him again: “It’s late, it’s time to collect the toys.” At best he nods. And more often he doesn’t react at all - he continues to play and that’s it.”
“I can ask my daughter for something ten times, but until I shout at you, you won’t get anything from her.”
“Until I scream, no one will even look at me. Sometimes it seems to me that they are deliberately taking me out.”
I don’t want to scream or swear. It is much more pleasant to be a kind, calm parent. But what to do when you said it once, said it twice and made no sense? Let's first figure out what exactly you shouldn't do. So, the child does not respond to comments.
What could make the situation worse?
Bribe
“If you stay quiet, I’ll give you some candy.” “Clean up your room and then you can play a computer game.”
Relationships take on the character of bargaining: “I will do this only if you...”. It’s sad when, when asked to “take out the trash,” a child responds: “What will I get for that?” I would like to explain: “Nothing will happen. It’s just that this is your home too, so come with us to make it cozy and clean.” It's a pity that words don't work instantly. Even the most fair and heartfelt ones. A child’s attitude towards his role in the family develops every day. It depends on your love for him, but not only. It is also important to be able to set boundaries and demand.
Persuasion
“Sasha (Mashenka, Petenka...) put away the toys, our place will be very clean. Well, take it away, please.”
Parents are forced to take this path by feelings of guilt and fear of being a “bad” mom (dad). Hence the endless persuasion, the inability to demand.
Once I had to go to the hospital with my child. The boxes there are separated by transparent partitions that do not reach the ceiling. Everyone hears and sees each other. A mother and son “settled” in the next box. The son is a head taller than his mother, but he was capricious like a baby.
- Why didn’t you take my coffee? I told you so! Where are the scissors? What? Didn't you take it too? Well okay! How were you planning? There is nothing.
Mom wasn't angry. She didn't even try to justify herself. In a quiet, insinuating voice, she consoled her son:
“I’ll bring everything to you tomorrow.” Maybe you can eat some yogurt in the meantime? Or sausages?
- How will I cut it for you? I don't need anything.
The offended son lay down facing the wall. Mom sat on the edge of the bed and stroked his back.
Scream
“Can you even hear me?!!! Got up and quickly went to the bathroom! In five minutes, your teeth will be brushed!”
Usually parents start shouting after many words have already been said. Sometimes, sensing the futility of a calm tone, shouting is used immediately. This seems like a tempting solution because it works. But there is one “but” - over time you need to scream stronger and more scary. And when this stops working, it’s not far from spanking and insults. Gradually, the calm tone completely ceases to be perceived by the child.
Raising your voice quickly becomes a habit. They shouted - it helped. Next time, the increased tone increases faster and easier. Then immediately, without resistance. Then it seemed like it was possible to say calmly, but the scream breaks out unexpectedly, on its own. And it seems that you no longer control your reactions, you let everything take its course.
Neurological development of a child in the first year of life. Inspection "Fundamental"
Salmagambetova Elena Garrievna
Neurologist
April 24, 2021
The development of a child in the first year of life occurs within a certain time frame. By the second month of life, your baby holds his head well, follows the object, walks, smiles; at 3-3.5 months – rolls over onto its side; at 4.5-5 – turns from back to stomach, takes toys; at 7 months - sits, crawls from 8, at 10-11 - stands on a support and begins to walk independently until one and a half years.
In general, according to generally accepted ideas, the absence of developmental delay is an important indicator of health. But it also happens that with relatively good psychomotor development, some disturbances in the overall harmony of movements arise, “discomfort”, which alarms attentive parents. The range of complaints is very wide - from a persistent tilt of the head to one side from 1.5-2 months to significant asymmetry in movements, gait disturbances after a year. Of course, gross anomalies are detected already in the maternity hospital. For example, congenital muscular torticollis, damage to the nerves of the brachial plexus (the baby’s arm is “flaccid”, straightened in all joints, brought to the body), congenital deformation of the feet, etc.
Many other diseases of the neuromotor system are typically diagnosed during the first year of life, usually with close collaboration between a neurologist and an orthopedic surgeon. Therefore, now they are even trying to distinguish neuroorthopedics as an independent field in medicine.
Early recognition of neuro-orthopedic problems, disorders in the development of bones and joint functions is very important, since as the child grows and develops, the manifestation of these conditions may intensify and, accordingly, more therapeutic measures will be required to cope with the disease.
The first examination takes place, on average, from 1.5 to 3 months. This inspection is “fundamental.” Information about the course of pregnancy and childbirth is carefully collected, complaints are assessed, the child is examined (don’t be surprised that the examination itself does not take much time - here the duration can tire the child and depress his responses). If there are suspicions of disturbances in the motor sphere, then during a subsequent examination (for example, after 1 month) the most important thing is to understand whether these signs are worsening. In addition, additional instrumental diagnostic methods often help us - ultrasound of the cervical spine and brain, ultrasound of the hip joints, radiography (according to strict indications), electroneuromyographic study (analysis of the activity of muscle and nerve fibers). But I repeat once again that many anomalies of body shape and movement functions in a small child are diagnosed clearly and definitively by comparison in dynamics.
Let's focus on the main points: “what to pay attention to?” (frequently asked by parents). It is very difficult to give an answer in a simple form, but to make it clear, let it sound like this:
- body position
- range of motion
- the presence of asymmetry in the motor sphere.
I will give examples.
When the baby lies on his back, his head is preferably turned to one side (forced position?) Normally, the head changes alternately in relation to the midline of the body, and may be slightly bent towards the chest.
The baby's shoulders are symmetrical on both sides. In a child under 3 months of age, the forearms may be slightly bent and the hands clenched into fists; this is normal. But if, when pulling yourself up by the handles, you can feel a weakening of flexion on both sides or a decrease in muscle strength on one side, this is no longer the norm.
We also pay attention to the child’s legs - are they strongly bent at the hip and knee joints, is there strong resistance when changing clothes, swaddling, or vice versa - lethargy, weakness, “hyperextension” are noted.
Now the baby begins to roll over and constantly on one side (as if he is sparing the other half of the body). Takes toys more boldly and clearly with one hand (the other “lags behind”). This is especially noticeable after 5.5 – 6 months.
Many people know the “fencing pose” (the dependence of muscle tone on turning the head) - one arm is extended and raised closer to the face, while the other is bent; the difference in the legs is weaker, but still there. Normally, this reflex disappears between 4 and 6 months of life. Its long-term preservation is beyond the norm.
When the baby lies on his stomach - at 4 months, the upper part of the body rests on the forearms and open palms, the legs are extended at the hip joints and bent at the knee joints. By 6 months, the legs are already fully extended. In pathology, these time frames are significantly disrupted.
If an infant is placed vertically, supported by the “armpits,” then at 4-5-6 months the legs can be straightened, and the child “stands” on his toes. But by the end of the 6-7th month the child is already resting on his entire foot. If there is hyperextension of the lower extremities with significant adduction, the ability to “stand” on the tips of the fingers remains after 8 months - these are symptoms of the disease.
The child is sitting, but we see that this requires a lot of tension in the extensor muscles - we are alarmed by this position.
The reaction “readiness to jump” looks very vivid (or the reaction “paratrooper reaction” - I read it in one German training manual). This is also the support reaction of the upper limbs.
An adult holds the child by the hips and allows the upper body to “fall” forward. The child “falls” onto outstretched arms, in most cases with open palms. Normal, checking this by 10-11 months.
You can list a lot in detail, but the main thing you need to understand is the reactions of holding the body, balance reactions, clear, purposeful movements, which must be formed in a certain sequence.
And now comes the child’s main achievement - he went! Not only did his skeleton and muscles become stronger, but his mind also matured, and there was a need to expand the boundaries of his “horizon.” When he walks 20-30 meters on his own, without support, we evaluate the gait and if everything is fine, we do not limit the need to walk, run, climb, not forgetting about constant sensitive control (injury prevention).
In the future, a healthy baby will need examinations by a neurologist and an orthopedist more than once a year.
He now has to master complex motor skills, in many ways consciously learning the beauty and dexterity of movements.
How to get your child to obey the first time?
Make sure your child can hear you.
Take his hand or touch him on the shoulder. Squat down so that your face is at the level of the child's face. Make eye contact.
Say what needs to be done and set a time frame.
“Will ten minutes be enough for you to finish?” Or: “Play for five more minutes and we’ll go home.” If you abruptly, without warning, pull a child out of the sandbox, interrupting the game at the most interesting place, this may cause a protest. And this is understandable. You don't like being distracted either.
Replace the minus with a plus.
Don't tell your child what NOT to do. Instead, tell him what he needs to do. For example, instead of “stop shouting,” it is more effective to say: “speak more quietly.”
Analyze what your communication consists of.
Do you talk to your child just like that? Without educational goals, without requirements and notations? Your son or daughter needs non-judgmental communication with you. Tell each other stories about your day, dream together. In a trusting relationship, children do not have to resist, defend their independence, take revenge, or attract attention, even negative attention. Consider the child's age. It is useless to demand from a one-year-old baby that he put everything back in place.
There shouldn't be too many requirements.
If mom constantly says something, demands, asks, points out, a defense mechanism is triggered. Her speech begins to be perceived as background. The meaning of the words no longer reaches consciousness. When there are many demands, it is also tiring for the parents themselves. It is difficult to monitor implementation. You get the feeling that you are pulling a carriage behind you, which moves with difficulty and creaks.
Features of behavioral disorders after stroke
After a stroke, various disturbances in the patient’s behavior can be observed. The most common are the following:
Emotional instability . Over a short period of time, the patient's mood can change several times from irritability and even aggression to a serene state or fun. He may get angry over a trifle - an incorrectly adjusted pillow, a curtain that is not drawn tightly, etc.
Emotional lability . In this case, the patient is apathetic, indifferent to both his own condition and those around him. It is very difficult to persuade him to do gymnastics, give him a massage, invite him to communicate or feed him.
Hypersensitivity . The patient becomes overly sensitive, tearful, capable of being offended over trifles and retains the offended state for a very long time. He often reproaches his relatives for lack of attention and communication, tasteless food or unpleasant sensations during procedures, and accuses them of deliberately causing him pain.
Depression . People who, before the stroke, led an active lifestyle and had varied interests and hobbies, are most prone to depression. A state of prolonged immobility causes them to become gloomy and depressed, and with prolonged depression, the patient often has thoughts of suicide. This is manifested in his behavior - he can ask his relatives to “ease his suffering”; when accessing the Internet, he can look for methods of suicide, find out information about euthanasia, etc.
Psychomotor disorders . In a state of strong excitement, the patient may begin to throw things that are within his reach. At the same time, he can shout, use foul language, and is not afraid to harm those who are nearby.
The listed disorders are greatly complicated by a lack of physical activity and sleep disturbances - circumstances that negatively affect the psychological state of even a healthy person.
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COST OF TREATMENT
How to cope with behavioral disorders in a patient
The patient’s relatives should first of all understand that this is the same person they loved and love. He hasn't changed, he'll just need a different attitude for some time. To make this time pass as quickly and comfortably as possible for both parties, listen to the following recommendations.
- Strictly follow all your doctor's instructions. Each point of therapy - from passive gymnastics to massage and hygiene procedures - is aimed at restoring certain body functions. When the patient tries to resist, do not give up, but always act softly and delicately. If the patient shows signs of severe agitation during treatment, postpone it for 1-2 hours and return to it when the patient calms down. If this behavior is repeated constantly, consult your doctor; he may consider it advisable to prescribe sedatives to the patient.
- Give the patient enough attention. Try to spend most of your time with him when he is awake. You can read a newspaper aloud to him, listen to an audiobook together, just talk - focus on how much the patient’s cognitive abilities are preserved and how much he enjoys certain activities.
- Do not be offended by the patient, even when he does not behave the way you want. Remember that brain dysfunction is a kind of computer breakdown. And it is natural that a person is simply not able to carry out some “programs” correctly.
- If it is psychologically difficult for you to care for a patient with severe behavioral disorders, it is advisable to use the help of a visiting nurse. Being in an unbalanced state, you will not help your loved one in any way and at the same time you will undermine your peace of mind.
