Spontaneous pneumothorax

A spontaneous pneumothorax is the sudden onset of a collapsed lung with the presence of air or gas in the pleural cavity (the space around the lungs) without any apparent cause, such as a traumatic injury to the chest or a known lung disease. This buildup of air puts pressure on the lung, so it cannot expand as much as it normally does when you take a breath. In most cases of spontaneous pneumothorax, a small area in the lung that is filled with air, called a bleb, ruptures, causing the air to leak into the space around the lung.

Spontaneous pneumothorax can be either small or large. A small spontaneous pneumothorax may resolve without treatment, while larger pneumothorax may need surgical intervention. Treatment for a pneumothorax usually involves inserting a flexible tube or needle between the ribs to remove the excess air.

In most cases of spontaneous pneumothorax, the cause is unknown. Tall and thin adolescent males are typically at greatest risk, but females can also have this condition. Other risk factors include connective tissue disorders, smoking, and activities such as scuba diving, high altitudes and flying.

Figure 1. Lungs pleural cavity

Figure 2. Collapsed and normal lung

Figure 3. A large, right-sided pneumothorax has occurred from a rupture of a subpleural bleb (chest X-ray).

Types of pneumothorax

There are different types of pneumothorax:

Primary spontaneous pneumothorax

Primary spontaneous pneumothorax is the most common type of pneumothorax, is described as primary because it has no known cause and develops in otherwise healthy people. Primary spontaneous pneumothorax is thought to be caused by a tiny tear of an outer part of the lung. Primary spontaneous pneumothorax is more common in tall people and mainly affects healthy young adults without lung disease.

Secondary spontaneous pneumothorax

Secondary spontaneous pneumothorax develops as a complication of existing lung disease, such as chronic obstructive pulmonary disease (COPD), pneumonia, tuberculosis, sarcoidosis or cystic fibrosis. The lung disease weakens the edge of the lung in some way, making the lung more likely to tear and cause air to escape.

Traumatic pneumothorax

Traumatic pneumothorax is a type of pneumothorax is caused by an incident such as a car accident, broken ribs or a stab wound.

Iatrogenic pneumothorax

Iatrogenic pneumothorax is a pneumothorax that occurs as a result of mechanical ventilation, which causes an imbalance in the air pressure around the lungs.

Tension pneumothorax

Tension pneumothorax is a pneumothorax (of any type) that leads to the heart and lungs not working properly. It is a medical emergency.

Spontaneous pneumothorax causes

Spontaneous means the pneumothorax was not caused by an injury such as a rib fracture. Primary spontaneous pneumothorax is likely due to the formation of small sacs of air (blebs) in lung tissue that rupture, causing air to leak into the pleural space. Air in the pleural space creates pressure on the lung and can lead to its collapse. A person with this condition may feel chest pain on the side of the collapsed lung and shortness of breath.

Blebs may be present on an individual’s lung (or lungs) for a long time before they rupture. Many things can cause a bleb to rupture, such as changes in air pressure or a very sudden deep breath. Often, people who experience a primary spontaneous pneumothorax have no prior sign of illness; the blebs themselves typically do not cause any symptoms and are visible only on medical imaging. Affected individuals may have one bleb to more than thirty blebs. Once a bleb ruptures and causes a pneumothorax, there is an estimated 13 to 60 percent chance that the condition will recur.

Spontaneous pneumothorax signs and symptoms

Spontaneous pneumothorax most commonly presents without severe symptoms.

Patients with a collapsed lung may experience a sudden onset of the following symptoms:

• Sharp chest pain, made worse by a deep breath or a cough
• Shortness of breath

A larger pneumothorax will cause more severe symptoms, including:

• Chest tightness
• Easy fatigue
• Rapid heart rate
• Bluish color of the skin caused by lack of oxygen
• Nasal flaring
• Chest wall retractions.

Until a bleb ruptures and causes pneumothorax, no clinical signs or symptoms are present in primary spontaneous pneumothorax. Young and otherwise healthy patients can tolerate the main physiologic consequences of a decrease in vital capacity and partial pressure of oxygen fairly well, with minimal changes in vital signs and symptoms, but those with underlying lung disease may have respiratory distress.

In one series, acute onset of chest pain and shortness of breath were present in all patients in one series; typically, both symptoms are present in 64-85% of patients. The chest pain is described as severe and/or stabbing, radiates to the ipsilateral (same side) shoulder and increases with inspiration (pleuritic).

In primary spontaneous pneumothorax, chest often improves over the first 24 hours, even without resolution of the underlying air accumulation. Well-tolerated primary spontaneous pneumothorax can take 12 weeks to resolve. In secondary spontaneous pneumothorax, the chest pain is more likely to persist with more significant clinical symptoms.

Shortness of breath/dyspnea in primary spontaneous pneumothorax is generally of sudden onset and tends to be more severe with secondary spontaneous pneumothorax because of decreased lung reserve. Anxiety, cough, and vague presenting symptoms (e.g, general malaise, fatigue) are less commonly observed. The most common underlying abnormality in secondary spontaneous pneumothorax is chronic obstructive pulmonary disease (COPD), and cystic fibrosis carries one of the highest associations, with more than 20% reporting spontaneous pneumothorax.

Despite descriptions of Valsalva maneuvers and increased intrathoracic pressures as inciting factors, spontaneous pneumothorax usually develops at rest. By definition, spontaneous pneumothorax is not associated with trauma or stress. Symptoms of iatrogenic pneumothorax are similar to those of a spontaneous pneumothorax and depend on the age of the patient, the presence of underlying lung disease, and the extent of the pneumothorax.

A history of previous pneumothorax is important, as recurrence is common, with rates reported between 15% and 40%. Up to 15% of recurrences can be on the contralateral (opposite) side. Secondary pneumothoraces are often more likely to recur, with cystic fibrosis carrying the highest recurrence rates at 68-90%. No study has shown that the number or size of blebs and bullae found in the lung can be used to predict recurrence.

Spontaneous pneumothorax diagnosis

If your child has a sudden onset of shortness of breath or sharp chest pain that is worsened by breathing, go to the Emergency Department to be evaluated or call 911. In order to make an accurate diagnosis, the medical team will evaluate your child’s symptoms and perform a physical exam, including the following:

• History: Your physician will obtain your child’s full medical history, in addition to assessing the symptoms she is currently experiencing. You may be asked questions about when the symptoms started, the severity of the pain or shortness of breath, and length of time you waited prior to arriving to the Emergency Department.
• Physical exam: Using a stethoscope, your child’s physician will listen for decreased or no breath sounds on the affected side.
• Chest X-ray: This radiologic test will show a pneumothorax if it is present.

Physical Examination

The presentation of a patient with pneumothorax may range from completely asymptomatic to life-threatening respiratory distress. Symptoms may include diaphoresis, splinting chest wall to relieve pleuritic pain, and cyanosis (in the case of tension pneumothorax). Findings on lung auscultation also vary depending on the extent of the pneumothorax. Affected patients may also reveal altered mental status changes, including decreased alertness and/or consciousness (a rare finding).

Respiratory findings may include the following:

• Respiratory distress (considered a universal finding) or respiratory arrest
• Tachypnea (or bradypnea as a preterminal event)
• Asymmetric lung expansion – A mediastinal and tracheal shift to the contralateral side can occur with a large tension pneumothorax
• Distant or absent breath sounds – Unilaterally decreased or absent lung sounds is a common finding, but decreased air entry may be absent even in an advanced state of the disease
• Lung sounds transmitted from the unaffected hemithorax are minimal with auscultation at the midaxillary line
• Hyperresonance on percussion – This is a rare finding and may be absent even in an advanced state of the disease
• Decreased tactile fremitus
• Adventitious lung sounds (crackles, wheeze; an ipsilateral finding)

Cardiovascular findings may include the following:

• Tachycardia – This is the most common finding. If the heart rate is faster than 135 beats/min, tension pneumothorax is likely
• Pulsus paradoxus
• Hypotension – This should be considered as an inconsistently present finding; although hypotension is typically considered a key sign of a tension pneumothorax, studies suggest that hypotension can be delayed until its appearance immediately precedes cardiovascular collapse
• Jugular venous distention – This is generally seen in tension pneumothorax, although it may be absent if hypotension is severe
• Cardiac apical displacement – This is a rare finding.

Tension pneumothorax

Although tension pneumothorax may be a difficult diagnosis to make and may present with considerable variability in signs, respiratory distress and chest pain are generally accepted as being universally present, and tachycardia and ipsilateral air entry on auscultation are also common findings. Sometimes, reliance on history alone may be warranted.

Findings may be affected by the volume status of the patient. In hypovolemic trauma patients with ongoing hemorrhage, the physical findings may lag behind the presentation of shock and cardiopulmonary collapse. Increased pulmonary artery pressures and decreased cardiac output or cardiac index are evidence of tension pneumothorax in patients with Swan-Ganz catheters.

When examining a patient for suspected tension pneumothorax, any clue may be helpful, as subtle thoracic size and thoracic mobility differences may be elicited by performing careful visual inspection along the line of the thorax. In a supine patient, the examiner should lower themselves to be on a level with the patient.

Tracheal deviation is an inconsistent finding. Although historic emphasis has been placed on tracheal deviation in the setting of tension pneumothorax, tracheal deviation is a relatively late finding caused by midline shift.

Abdominal distention may occur from increased pressure in the thoracic cavity producing caudal deviation of the diaphragm and from secondary pneumoperitoneum produced as air dissects across the diaphragm through the pores of Kohn.

If patients who are mechanically ventilated are difficult to ventilate during resuscitation, high peak airway pressures are clues to pneumothorax. A tension pneumothorax causes progressive difficulty with ventilation as the normal lung is compressed. On volume-control ventilation, this is indicated by marked increase in both peak and plateau pressures, with relatively preserved peak and plateau pressure difference. On pressure control ventilation, tension pneumothorax causes sudden drop in tidal volume. However, these observations are neither sensitive nor specific for making the diagnosis of pneumothorax or ruling out the possibility of pneumothorax.

The development of tension pneumothorax in patients who are ventilated will generally be of faster onset with immediate, progressive arterial and mixed venous oxyhemoglobin saturation decline and immediate decline in cardiac output. Cardiac arrest associated with asystole or pulseless electrical activity (PEA) may ultimately result. Occasionally, the tension pneumothorax may be tolerated and its diagnosis delayed for hours to days after the initial insult. The diagnosis may become evident only if the patient is receiving positive-pressure ventilation. Tension pneumothorax has been reported during surgery with both single- and double-lumen tubes.

Spontaneous pneumothorax treatment

Treatment of spontaneous pneumothorax depends on the duration, severity of symptoms and size of pneumothorax.

Patients who seek treatment for minimal or resolving symptoms after more than 24 hours will receive a chest X-ray to determine treatment. If the imaging reveals only a small pneumothorax, the patient may only require oxygen supplementation and observation in the hospital for a brief period of time.

Patients with large pneumothorax who seek treatment within a short time of the onset and present more severe symptoms may require placement of a chest tube (inserted between the ribs) to release the tension. In most cases, the placement of the chest tube allows the lung to re-expand fully and quickly.

The chest tube can be left in place for several days. During that time, your child must stay in the hospital for continued evaluation. She will undergo a series of chest X-rays to monitor the pneumothorax and determine if it is improving or worsening.

Some patients with a pneumothorax may also receive supplemental oxygen, which may improve symptoms and can help the air around the lung be reabsorbed more quickly.

Patients with a persistent air leak from the chest tube for more than five days or those with recurrent or bilateral spontaneous pneumothorax may be candidates for surgery.

A tension pneumothorax should be treated with immediate decompression with a needle in the 2nd intercostal space (between the second and third rib at the front). This is then followed by a formal intercostal tube insertion as above.

Surgery for spontaneous pneumothorax

Patients with a persistent air leak from the chest tube for more than five days or those with recurrent or bilateral spontaneous pneumothorax may be candidates for surgery.

Goals of surgery:

• Identify bullae (blebs) responsible for the air leak and remove them if they are present.
• Obliterate the pleural space and minimize the chances for future lung collapse.

The operation is usually performed using a video-assisted thoracic surgery (VATS), with two to four small incisions.

After surgery

After your child has surgery to treat spontaneous pneumothorax, she will spend an hour or so recovering in the post-acute care unit before returning to a room in the hospital. She will likely have a chest tube after the operation, which may need to remain in place for a number of days.

Your child will experience some pain and will receive pain medications throughout the stay. Some patients will initially require IV pain medications and then transition to oral pain medications. The pain management team will work with the surgical team and your child to provide adequate pain control.

Your child may have chest incisions with a clear adhesive glue dressing or gauze covering the site. The clear adhesive will dissolve and peel off naturally; the gauze dressings will be removed 48-72 hours after surgery.

Follow-up care

If your child has an operation or receives inpatient treatment with a chest tube or oxygen therapy to treat spontaneous pneumothorax, you will need to make an appointment to see the surgeon for follow-up three to four weeks after discharge. After your child has been treated for spontaneous pneumothorax, it is important that you carefully monitor her health.

Pregnant blurred vision

Vision problems can be caused by different issues in pregnancy. If you have vision problems always tell your doctor or hospital straight away.

Vision problems such as blurring or flashing lights in your eyes could be caused by:

• a migraine
• pregnancy induced hypertension (high blood pressure in pregnancy). This is a type of high blood pressure that develops after 20 weeks and goes away within 6 weeks of the baby’s birth. It’s also known as gestational high blood pressure or gestational hypertension.
• water retention, which may affect the front of your eyes and change your vision slightly
• pre-eclampsia.

Hypertensive disorders are seen in 10% of all pregnancies. These hypertensive disorders include gestational hypertension, preeclampsia, eclampsia, and HELLP syndrome. Preeclampasia/eclampsia and HELLP syndrome can present with retinal disturbances, and serous retinal detachment can be found in 1-2% of the cases presenting with preeclampsia/eclampsia.

Pre-eclampsia is a kind of high blood pressure and is a serious pregnancy condition that usually happens after 20 weeks. Other symptoms can include:

• a sudden increase in swelling in your face, hands or feet
• a very bad headache or a dull headache that won’t go away
• severe pain just below your ribs
• feeling sick or vomiting
• feeling unwell.

Most pregnant women with preeclampsia have healthy babies. But if not treated, it can cause serious problems, like premature birth and even death. If you’re at risk for preeclampsia, your doctor may want you to take low-dose aspirin to help prevent it. Treatment depends on how severe your preeclampsia is and how far along you are in your pregnancy. Even if you have mild preeclampsia, you need treatment to make sure it doesn’t get worse.

If you have blurred vision, swelling in your hands and face or severe headaches or belly pain, see your doctor right away.

You can have preeclampsia and not know it, so go to all of your prenatal care visits, even if you’re feeling fine.

What is high blood pressure in pregnancy?

Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. Each time your heart beats, it pumps blood to the arteries. If the pressure in your arteries becomes too high, you have high blood pressure also called hypertension. High blood pressure can put extra stress on your organs. This can lead to heart attack, heart failure, stroke and kidney failure.

Some women have high blood pressure before they get pregnant. Others have high blood pressure for the first time during pregnancy. About 8 in 100 women (8 percent) have some kind of high blood pressure during pregnancy. If you have high blood pressure, talk to your health care provider. Managing your blood pressure can help you have a healthy pregnancy and a healthy baby.

High blood pressure during pregnancy key points

• High blood pressure can cause problems for you and your baby during pregnancy, including preeclampsia and premature birth.
• High blood pressure usually doesn’t cause signs or symptoms. Go to all of your prenatal care visits so your provider can check your blood pressure.
• If you need medicine to keep your blood pressure under control, take it every day.
• If you’re at high risk for preeclampsia, your provider may want you to take low-dose aspirin to help prevent it.

What kinds of high blood pressure can affect pregnancy?

Two kinds of high blood pressure that can happen during pregnancy:

1. Chronic hypertension. This is high blood pressure that you have before you get pregnant or that develops before 20 weeks of pregnancy. It doesn’t go away once you give birth. About 1 in 4 women with chronic hypertension (25 percent) has preeclampsia during pregnancy. If you’re at high risk for preeclampsia, your doctor may treat you with low-dose aspirin to prevent it. If you have chronic hypertension, your doctor checks your blood pressure and urine at each prenatal care visit. You may need to check your blood pressure at home, too. Your doctor may use ultrasound and fetal heart rate testing to check your baby’s growth and health. Your doctor also checks for signs of preeclampsia. If you were taking medicine for chronic hypertension before pregnancy, your doctor makes sure it’s safe to take during pregnancy. If it’s not, he switches you to a safer medicine. Some blood pressure medicines, called ACE inhibitors and angiotensin receptor blockers, can harm your baby during pregnancy. During the first half of pregnancy, blood pressure often falls. If you have mild hypertension and took medicine for it before pregnancy, your doctor may lower the dose of medicine you take. Or you may be able to stop taking medicine during pregnancy. Don’t stop taking any medicine before you talk to your health care doctor. Even if you didn’t take blood pressure medicine in the past, you may need to start taking it during pregnancy.
2. Gestational hypertension. This is high blood pressure that only pregnant women can get. It starts after 20 weeks of pregnancy and usually goes away after you give birth. It usually causes a small rise in blood pressure, but some women develop severe hypertension and may be at risk for more serious complications later in pregnancy, like preeclampsia. During pregnancy, your doctor checks your blood pressure and urine at every prenatal care checkup. She may use ultrasound and fetal heart rate testing to check your baby’s growth and health. Your doctor may ask you to check your blood pressure at home and do kick counts to see when and how often your baby moves. Here are two ways to do kick counts:
   1. Every day, time how long it takes for your baby to move ten times. If it takes longer than 2 hours, tell your doctor.
   2. See how many movements you feel in 1 hour. Do this three times each week. If the number changes, tell your doctor.

Doctors don’t know how to prevent gestational hypertension. But if you’re overweight or obese, getting to a healthy weight before pregnancy may lower your chances of having this condition. And even though gestational hypertension usually goes away after birth, you may be more likely to develop hypertension later in life. Healthy eating, staying active and getting to a healthy weight after pregnancy can help prevent high blood pressure in the future.

How do I know if I have high blood pressure?

Your blood pressure reading is given as two numbers:

• Systolic blood pressure. This is the upper (first) number in your reading. It’s the pressure when you heart contracts (gets tight). Your blood pressure is highest when your heart beats and pumps blood.
• Diastolic blood pressure. This is the lower (second) number in your reading. It’s the pressure when your heart relaxes. Your blood pressure falls because your heart is at rest between beats.

Your blood pressure reading fits into one of five categories:

1. Normal. Your blood pressure is less than 120/80.
2. Elevated. This is when your systolic blood pressure is between 120-129 and your diastolic pressure is less than 80.
3. Stage 1 high blood pressure. This is when your systolic pressure is between 130-139 or your diastolic pressure is between 80-89.
4. Stage 2 high blood pressure. This is when your systolic pressure is at least 140 or your diastolic is at least 90.
5. Hypertensive crisis. This is when your systolic pressure is higher than 180 and/or your diastolic pressure is higher than 120. Call your health care doctor right away if your blood pressure is this high.

At each prenatal care checkup, your doctor checks your blood pressure. To do this, she wraps a cuff (band) around your upper arm. She pumps air into the cuff to measure the pressure in your arteries when the heart contracts and then relaxes. If you have a high reading, your doctor can recheck it to find out for sure if you have high blood pressure. Your blood pressure can go up or down during the day.

What pregnancy complications can high blood pressure cause?

High blood pressure can cause problems for you and your baby during pregnancy, including:

Problems for moms include:

• Preeclampsia. This is when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs and symptoms of preeclampsia include having protein in the urine, changes in vision and severe headaches. Preeclampsia can be a serious medical condition. Even if you have mild preeclampsia, you need treatment to make sure it doesn’t get worse. Without treatment, preeclampsia can cause serious health problems, including kidney, liver and brain damage. In rare cases, it can lead to life-threatening conditions called eclampsia and HELLP syndrome. Eclampsia causes seizures and can lead to coma. HELLP syndrome is when you have serious blood and liver problems. HELLP stands for hemolysis (H), elevated liver enzymes (EL), low platelet count (LP).
• Gestational diabetes. This is a kind of diabetes that only pregnant women get. It’s a condition in which your body has too much sugar (also called glucose). Most women get a test for gestational diabetes at 24 to 28 weeks of pregnancy.
• Heart attack also called myocardial infarction.
• Kidney failure. This is a serious condition that happens when the kidneys don’t work well and allow waste to build up in the body.
• Placental abruption. This is a serious condition in which the placenta separates from the wall of the uterus before birth. If this happens, your baby may not get enough oxygen and nutrients in the womb. You also may have serious bleeding from the vagina. The placenta grows in the uterus and supplies the baby with food and oxygen through the umbilical cord.
• Postpartum hemorrhage. This is when a woman has heavy bleeding after giving birth. It’s a serious but rare condition. It usually happens 1 day after giving birth, but it can happen up to 12 weeks after having a baby.
• Pulmonary edema. This is when fluid fills the lungs and leads to shortness of breath.
• Stroke. This is when blood flow to your brain stops. Stroke can happen if a blood clot blocks a vessel that brings blood to the brain or when a blood vessel in the brain bursts open.
• Pregnancy related death. This is when a woman dies during pregnancy or within 1 year after the end of her pregnancy from health problems related to pregnancy.

If you have high blood pressure during pregnancy, you’re also more likely have a cesarean birth (also called c-section). This is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus.

Problems for babies include:

• Premature birth. This is birth that happens too early, before 37 weeks of pregnancy. Even with treatment, a pregnant woman with severe high blood pressure or preeclampsia may need to give birth early to avoid serious health problems for her and her baby.
• Fetal growth restriction. High blood pressure can narrow blood vessels in the umbilical cord. This is the cord that connects the baby to the placenta. It carries food and oxygen from the placenta to the baby. If you have high blood pressure, your baby may not get enough oxygen and nutrients, causing him to grow slowly.
• Low birthweight. This is when a baby is born weighing less than 5 pounds, 8 ounces.
• Fetal death. When a baby dies spontaneously in the womb at any time during pregnancy.
• Neonatal death. This is when a baby dies in the first 28 days of life.

How is high blood pressure during pregnancy treated?

Here’s what you can do:

• Go to all your prenatal care checkups, even if you’re feeling fine.
• If you need medicine to control your blood pressure, take it every day. Your doctor can help you choose one that’s safe for you and your baby.
• Check your blood pressure at home. Ask your doctor what to do if your blood pressure is high.
• Eat healthy foods. Don’t eat foods that are high in salt, like soup and canned foods. They can raise your blood pressure.
• Stay active. Being active for 30 minutes each day can help you manage your weight, reduce stress and prevent problems like preeclampsia.
• Don’t smoke, drink alcohol or use street drugs or abuse prescription drugs.

What can I do about high blood pressure before pregnancy?

Here’s what you can do:

• Get a preconception checkup. This is a medical checkup you get before pregnancy to take care of health conditions that may affect your pregnancy.
• Use birth control until your blood pressure is under control. Birth control is methods you can use to keep from getting pregnant. Condoms and birth control pills are examples of birth control.
• Get to a healthy weight. Talk to your doctor about the weight that’s right for you.
• Eat healthy foods.
• Do something active every day.
• Don’t smoke. Smoking is dangerous for people with high blood pressure because it damages blood vessel walls.

What is HELLP syndrome?

HELLP syndrome is a serious pregnancy complication that affects the blood and liver. HELLP stands for these blood and liver problems:

• H–Hemolysis. This is the breakdown of red blood cells. Red blood cells carry oxygen from your lungs to the rest of your body.
• EL–Elevated liver enzymes. High levels of these chemicals in your blood can be a sign of liver problems.
• LP–Low platelet count. Platelets are little pieces of blood cells that help your blood clot. A low platelet count can lead to serious bleeding.

HELLP syndrome is rare. It happens in about 1 to 2 of 1,000 pregnancies. HELLP usually develops in the third trimester of pregnancy, but it sometimes develops in the week after a baby is born. If you have HELLP syndrome, the liver may bleed, causing pain in your chest or belly. It’s is a medical emergency that needs quick treatment. Without early treatment, 1 out of 4 women (25 percent) with HELLP has serious complications. Without any treatment, a small number of women die.

If you’ve had HELLP syndrome in a past pregnancy, tell your provider. Getting early and regular prenatal care can help reduce your risk of having HELLP again. Going to all your prenatal care checkups allows your health care provider to find and treat problems like HELLP early.

HELLP syndrome usually goes away after giving birth.

What causes HELLP syndrome?

Scientists don’t know what causes HELLP syndrome. You’re at risk for HELLP if you have preeclampsia or eclampsia. About 1 to 2 in 10 pregnant women (10 to 20 percent) with preeclampsia or eclampsia develop HELLP. Preeclampsia is a serious blood pressure condition that can happen after the 20th week of pregnancy or after giving birth (called postpartum preeclampsia). It’s when a woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy. Eclampsia is when preeclampsia is uncontrolled and causes seizures. Seizures are sudden, abnormal electrical activity in the brain that can cause changes in behavior, movement, feelings and consciousness.

What are signs and symptoms of HELLP syndrome?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy. Signs and symptoms of HELLP syndrome can appear during pregnancy or after giving birth. Some women develop HELLP suddenly, without having any signs or symptoms.

Signs and symptoms of HELLP syndrome include:

• Blurry vision
• Chest pain or pain in the upper right or middle part of the belly
• Headache, fatigue (feeling really tired) or feeling unwell
• Nausea (feeling sick to your stomach) or throwing up that gets worse
• Quick weight gain and swelling
• Nosebleed or other bleeding that doesn’t stop. This is rare.
• Seizures or convulsions. This is rare. Convulsions are when your body shakes quickly and without control.

If you have any signs or symptoms of HELLP syndrome, call your health care provider or emergency services (911) or go to a hospital emergency room for medical care right away.

Signs and symptoms of HELLP syndrome are the same as for other health conditions. So sometimes HELLP is misdiagnosed as:

• Flu or other illness caused by a virus
• Gallbladder disease. The gallbladder is an organ under your liver that stores bile, a fluid your liver makes to help the body break down fat.
• Hepatitis. This is inflammation (swelling) of the liver.
• Idiopathic thrombocytopenic purpura (also called ITP). This is a bleeding disorder. If you have idiopathic thrombocytopenic purpura, you may bruise easily or have a lot of bruising (also called purpura). You also may bleed easily or heavily. For example, you may have bleeding from the gums or nose or bleeding into the skin that looks like a rash of pinpoint red spots.
• Lupus flare. A lupus flare is a period of time when you have many or intense lupus symptoms. Lupus is an autoimmune disorder that can cause health problems during pregnancy.
• Autoimmune disorders are health conditions that happen when antibodies (cells in the body that fight off infections) attack healthy tissue by mistake. Lupus and other autoimmune disorders can cause swelling, pain and sometimes organ damage. Lupus also can affect joints, skin, kidneys, lungs and blood vessels.
• Thrombotic thrombocytopenic purpura. This is a rare condition that causes blood clots to form in small blood vessels throughout the body. These clots can cause serious health problems if they block the flow of blood to organs, like the brain, kidneys and heart.

What health problems can HELLP cause?

HELLP syndrome can cause:

• Bleeding and blood clotting problems. Some women with HELLP develop disseminated intravascular coagulation (also called DIC). This is a blood clotting disorder than can lead to heavy bleeding (also called hemorrhage).
• Fluid buildup in the lungs (also called pulmonary edema). This can cause breathing problems.
• Kidney failure
• Liver hemorrhage or failure
• Placental abruption. This is a serious condition in which the placenta separates from the wall of the uterus before birth.

How is HELLP syndrome diagnosed?

To find out if you have HELLP syndrome, your provider does a physical exam to check you for:

• Belly pain or soreness, especially in the upper right side
• An enlarged liver
• High blood pressure
• Swelling in your legs

Your doctor may do blood tests to check your liver enzyme levels and your platelet count. He may do a CT scan to see if there’s bleeding in your liver. A CT scan is a test that uses X-rays and computers to take pictures of your body.

Your doctor may do tests like a non-stress test or ultrasound to check your baby’s health. A non-stress test (also called NST or fetal heart rate monitoring) checks your baby’s heart rate in the womb to see how the heart rate changes when your baby moves. Your provider uses this test to make sure your baby’s getting enough oxygen. Ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb.

Many women are diagnosed with preeclampsia before they have HELLP. Sometimes signs and symptoms of HELLP symptoms are the first signs of preeclampsia.

How is HELLP syndrome treated?

If you have HELLP, your provider may give you medicine to control your blood pressure and prevent seizures. You may need a blood transfusion. This is when you have new blood put into your body.

If you have HELLP syndrome, you may need to give birth as soon as possible. This may mean that your baby is born prematurely, before 37 weeks of pregnancy. Early birth may be necessary because HELLP complications can get worse and harm both you your baby. If you’re giving birth early, your provider may give you medicines called antenatal corticosteroids to help speed your baby’s lung growth. Your provider can induce labor (make labor start) with medicine or other methods. Or you may have your baby by cesarean birth (also called c-section). This is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus.

What is preeclampsia?

Preeclampsia is a serious blood pressure condition that can happen after the 20th week of pregnancy or after giving birth called postpartum preeclampsia. It’s when a woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working normally. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. High blood pressure (also called hypertension) is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy.

Preeclampsia is a serious health problem for pregnant women around the world. It affects 2 to 8 percent of pregnancies worldwide (2 to 8 in 100). In the United States, it’s the cause of 15 percent (about 3 in 20) of premature births. Premature birth is birth that happens too early, before 37 weeks of pregnancy.

Most women with preeclampsia have healthy babies. But if it’s not treated, it can cause severe health problems for you and your baby.

What causes preeclampsia?

Scientists don’t know for sure what causes preeclampsia, but there are some things that may make you more likely than other women to have it. These are called risk factors. If you have even one risk factor for preeclampsia, tell your doctor.

You’re at high risk for preeclampsia if:

• You’ve had preeclampsia in a previous pregnancy. The earlier in pregnancy you had preeclampsia, the higher your risk is to have it again in another pregnancy. You’re also at higher risk if you had preeclampsia along with other pregnancy complications.
• You’re pregnant with multiples (twins, triplets or more).
• You have high blood pressure, diabetes, kidney disease or an autoimmune disease like lupus or antiphospholipid syndrome. Diabetes is when you have too much sugar in the blood. This can damage organs, like blood vessels, nerves, eyes and kidneys. An autoimmune disease is a health condition that happens when antibodies (cells in the body that fight off infections) attack healthy tissue by mistake.

Other risk factors for preeclampsia include:

• You’ve never had a baby before, or it’s been more than 10 years since you had a baby.
• You’re obese. Obese means being very overweight with a body mass index (also called BMI) of 30 or higher.
• You have a family history of preeclampsia. This means that other people in your family, like your sister or mother, have had it.
• You had complications in a previous pregnancy, like having a baby with low birthweight. Low birthweight is when your baby is born weighing less than 5 pounds, 8 ounces.
• You had a fertility treatment called in vitro fertilization (also called IVF) to help you get pregnant.
• You’re older than 35.
• You’re African-American. African-American women are at higher risk for preeclampsia than other women.
• You have low socioeconomic status. Socioeconomic status is a combination of things, like a person’s education level, job and income (how much money you make). A person with low socioeconomic status may have little education, may not have a job that pays well and may have little income or savings.

If your provider thinks you’re at risk of having preeclampsia, he may want to treat you with low-dose aspirin to help prevent it. Talk to your doctor to see if treatment with low-dose aspirin is right for you.

How can preeclampsia affect me and my baby?

Without treatment, preeclampsia can cause serious health problems for you and your baby, even death. You may have preeclampsia and not know it, so be sure to go to all your prenatal care checkups, even if you’re feeling fine. If you have any sign or symptom of preeclampsia, tell your doctor.

Health problems for women who have preeclampsia include:

• Kidney, liver and brain damage
• Problems with how your blood clots. A blood clot is a mass or clump of blood that forms when blood changes from a liquid to a solid. Your body normally makes blood clots to stop bleeding after a scrape or cut. Problems with blood clots can cause serious bleeding problems.
• Eclampsia. This is a rare and life-threatening condition. It’s when a pregnant woman has seizures or a coma after preeclampsia. A coma is when you’re unconscious for a long period of time and can’t respond to voices, sounds or activity.
• Stroke. This is when the blood supply to the brain is interrupted or reduced. Stroke can happen when a blood clot blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open.

Pregnancy complications from preeclampsia include:

• Premature birth. Even with treatment, you may need to give birth early to help prevent serious health problems for you and your baby.
• Placental abruption. This is when the placenta separates from the wall of the uterus (womb) before birth. It can separate partially or completely. If you have placental abruption, your baby may not get enough oxygen and nutrients. Vaginal bleeding is the most common symptom of placental abruption after 20 weeks of pregnancy. If you have vaginal bleeding during pregnancy, tell your health care doctor right away.
• Intrauterine growth restriction (IUGR). This is when a baby has poor growth in the womb. It can happen when mom has high blood pressure that narrows the blood vessels in the uterus and placenta. The placenta grows in the uterus and supplies your baby with food and oxygen through the umbilical cord. If your baby doesn’t get enough oxygen and nutrients in the womb, he may have IUGR.
• Low birthweight

Having preeclampsia increases your risk for postpartum hemorrhage. Postpartum hemorrhage is heavy bleeding after giving birth. It’s a rare condition, but if not treated, it can lead to shock and death. Shock is when your body’s organs don’t get enough blood flow.

Having preeclampsia increases your risk for heart disease, diabetes and kidney disease later in life.

What are the signs and symptoms of preeclampsia?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy.

Signs and symptoms of preeclampsia include:

• Changes in vision, like blurriness, flashing lights, seeing spots or being sensitive to light
• Headache that doesn’t go away
• Nausea (feeling sick to your stomach), vomiting or dizziness
• Pain in the upper right belly area or in the shoulder
• Sudden weight gain (2 to 5 pounds in a week)
• Swelling in the legs, hands or face
• Trouble breathing

Many of these signs and symptoms are common discomforts of pregnancy. If you have even one sign or symptom, call your doctor right away.

How is preeclampsia diagnosed?

To diagnose preeclampsia, your doctor measures your blood pressure and tests your urine for protein at every prenatal visit.

Your doctor may check your baby’s health with:

• Ultrasound. This is a prenatal test that uses sound waves and a computer screen to make a picture of your baby in the womb. Ultrasound checks that your baby is growing at a normal rate. It also lets your doctor look at the placenta and the amount of fluid around your baby to make sure your pregnancy is healthy.
• Nonstress test. This test checks your baby’s heart rate.
• Biophysical profile. This test combines the nonstress test with an ultrasound.

How is mild preeclampsia treated?

Most women with mild preeclampsia after 37 weeks of pregnancy don’t have serious health problems. If you have mild preeclampsia before 37 weeks:

• Your doctor checks your blood pressure and urine regularly. She may want you to stay in the hospital to monitor you closely. If you’re not in the hospital, your doctor may want you to have checkups once or twice a week. She also may ask you to take your blood pressure at home.
• Your doctor may ask you to do kick counts to track how often your baby moves. There are two ways to do kick counts: Every day, time how long it takes for your baby to move ten times. If it takes longer than 2 hours, tell your doctor. Or three times a week, track the number of times your baby moves in 1 hour. If the number changes, tell your doctor.
• If you’re at least 37 weeks pregnant and your condition is stable, your doctor may recommend that you have your baby early. This may be safer for you and your baby than staying pregnant. Your doctor may give you medicine or break your water (amniotic sac) to make labor start. This is called inducing labor.

How is severe preeclampsia treated?

If you have severe preeclampsia, you most likely stay in the hospital so your doctor can closely monitor you and your baby. Your doctor may treat you with medicines called antenatal corticosteroids. These medicines help speed up your baby’s lung development. You also may get medicine to control your blood pressure and medicine to prevent seizures (called magnesium sulfate).

If your condition gets worse, it may be safer for you and your baby to give birth early. Most babies of moms with severe preeclampsia before 34 weeks of pregnancy do better in the hospital than by staying in the womb. If you’re at least 34 weeks pregnant, your doctor may recommend that you have your baby as soon as your condition is stable. Your doctor may induce your labor, or you may have a c-section. If you’re not yet 34 weeks pregnant but you and your baby are stable, you may be able to wait to have your baby.

If you have severe preeclampsia and HELLP syndrome, you almost always need to give birth early. HELLP syndrome is a rare but life-threatening liver disorder. About 2 in 10 women (20 percent) with severe preeclampsia develop HELLP syndrome. You may need medicine to control your blood pressure and prevent seizures. Some women may need blood transfusions. A blood transfusion means you have new blood put into your body.

What causes blurred vision during pregnancy?

There are multiple reasons as to why pregnant ladies experience a hazy vision. The most prominent reason is pregnancy hormones. They cause fluid retention which alters the cornea to make it thicker, along with an increase in the fluid pressure within the eyeball. This results in a blurred vision. Another effect of these hormones is that they decrease the tear production which in turn diminishes the acuity of vision.

Expecting mothers with other health conditions such as preeclampsia or gestational diabetes can also suffer from vision problems. Apart from blurry vision, preeclampsia can cause light sensitivity, temporary vision loss, auras and flashes of light. And, gestational diabetes can cause alterations in the cornea and even damage the retina. So the blood sugar levels should be monitored regularly and if distorted vision persists, a physician should be consulted immediately.

Even increased progesterone levels during pregnancy can cause the tissues of cornea to soften. This can also lead to unclear or doubled vision.

Blurred vision during pregnancy treatment

If you have any vision problems – even if you don’t have any other symptoms – see your doctor or go to hospital maternity unit straight away.

Baby gagging

Baby gagging on food is an automatic response that helps prevent choking. Some babies and children have problems taking and swallowing food that is not smooth. Until your baby’s about 4 to 6 months old, your baby has a gag reflex that causes him to thrust his tongue forward whenever the back of his throat is stimulated. This tongue-thrust reflex can make early feedings a bit of a challenge. Gagging or pushing out those first spoonfuls of cereal isn’t uncommon. If your child gags when given pureed foods that are not smooth, it may be because of a sensitive gag reflex.

Gagging is a normal reflex babies have as they learn to eat solids, whether they are spoon-fed or you’re doing baby-led weaning. Gagging brings food forward into your baby’s mouth so he can chew it some more first or try to swallow a smaller amount. Your baby should gag less often as he develops and learns to regulate the amount of food he swallows.

Some children will gag or vomit when they are given pureed foods that are not smooth. This is often caused by a very sensitive gag reflex. Offering only smooth foods and hoping that the problem will go away does not always work.

There are a few things you can do to help make your child’s gag reflex less sensitive.

These children will often do well with smooth pureed foods, such as commercial first baby foods in jars. When they are given pureed foods that are not smooth, they will often gag and sometimes vomit (throw up). As a result, their parents will often go back to the smooth purees, which the child likes.

These children continue to eat only smooth pureed foods and do not have the chance to learn to eat foods with texture. They also do not have the chance to learn to chew. Some children will be able to tolerate food with lumps in their mouth but will gag if they try to swallow lumps. As a result, these children will spit out lumps and only swallow the smooth part of food.

If your baby pushes the food out with his tongue, it doesn’t necessarily mean that he doesn’t like it — he’s probably just trying to figure out this new way of eating. Feed him slowly while he gets the hang of it.

After a few tries, he should start using his tongue to move the food to the back of his mouth. If your baby is still having trouble swallowing the food after a week, he’s probably just not ready for solids yet.

Once your baby’s ready for table food, keep an eye on him so that he doesn’t choke while feeding himself. Cut his food up into bite-size pieces no larger than 1/2 inch and avoid foods that are choking hazards, such as whole grapes, nuts, and popcorn.

Most likely your baby will gag less as he gets more meals under his belt. If he continues to gag on pureed foods, mention it to his doctor. She can check for physical problems, just to be sure.

How can I tell if my baby is gagging or choking?

Gagging is different from choking.Choking means your child’s airway is partially or completely blocked, which prevents breathing. Here’s how to recognize the difference between gagging and choking:

• A child who is gagging may push his tongue forward or out of his mouth and do a retching movement to try to bring food forward. His eyes may water. He may cough or even vomit. Let your child continue to gag and cough because that’s the most effective way to resolve the problem.
• A child who is choking is unable to cry, cough, or gasp. He may make odd noises or no sound at all while opening his mouth. You may need to do back blows or chest thrusts to dislodge the blockage.

Choking prevention

Choking can be prevented. Food accounts for over 50% of choking episodes.

But, also be alert for small objects that can cause choking, such as coins, buttons, and small toys. Check under furniture and between cushions for small items that children could find and put in their mouths.

Toys are designed to be used by children within a certain age range. Age guidelines take into account the safety of a toy based on any possible choking hazard. Don’t let young children play with toys designed for older children.

Keep items that are choking hazards away from babies and young children. These include:

• Coins
• Buttons
• Toys with small parts
• Toys that can fit entirely in a child’s mouth
• Small balls, marbles
• Balloons
• Small hair bows, barrettes, rubber bands
• Pen or marker caps
• Small button-type batteries
• Refrigerator magnets
• Pieces of dog food

Choking hazard foods

Some foods can cause choking. Keep foods such as grapes, hot dogs, raw carrots, or peanuts away from babies and young children. Cut food for babies and young children into pieces no larger than one-half inch. Encourage children to chew food well. Supervise meal times. Insist that children sit down while eating. Children should never run, walk, play, or lie down with food in their mouths. Be aware of older children’s actions. Many choking incidents are caused when an older child gives a dangerous toy or food to a younger child.

Keep the following foods away from children younger than 4 years:

• Hot dogs
• Nuts and seeds
• Chunks of meat or cheese
• Whole grapes
• Hard or sticky candy
• Popcorn
• Chunks of peanut butter
• Chunks of raw vegetables
• Chewing gum

What causes baby gagging?

Children who gag when trying to eat foods that are lumpy or have texture often have a very sensitive gag reflex. The gag reflex helps you to expel food that your body feels is unsafe for you to swallow. The gag is usually triggered somewhere on the tongue.

Children with a very sensitive gag reflex tend to gag more easily than other children on food that is not smooth. This often looks very scary, as the child can turn red and appear quite distressed. Sometimes the gagging will lead to vomiting.

The difference between a sensitive gag reflex and a swallowing problem

It is common for parents to think that gagging when eating is caused by a problem with swallowing. However, there is a difference between a sensitive gag reflex and a swallowing problem:

• Children who have a very sensitive gag reflex will gag when new foods are still in their mouth, before they have tried to swallow the food. This can occur when the food is near the front, middle or back of the mouth.
• Children with a swallowing problem have trouble after the food has been swallowed. They may gag or choke.

Chewing problems can also cause gagging

Children can have problems with textured food because they have trouble chewing:

• Some children have difficulty chewing solid food in order to make it safe to swallow. These children will try to swallow a piece of food before it is properly broken down. This can cause them to gag and sometimes choke. This is often seen when children are first learning to chew.
• Children who have delays in their motor skills will often also have delays in their chewing skills as well.

If your child is gagging with some solids, make sure they can properly chew the food that they are being given.

How you can help your child with a very sensitive gag reflex

Children who have a very sensitive gag reflex usually need some help to improve. Just going back to offering only smooth foods and hoping that as the child gets older, their feeding will improve, does not always work. Most children with very sensitive gag reflexes need to experience the feeling of texture in their mouth and throat in order to make their gag reflex less sensitive.

Smooth foods with lumps, such as yogurt with pieces of fruit, are often the most difficult for children with a very sensitive gag reflex. This is because the child feels a smooth texture and then the lump is a surprise. This can cause the child to gag.

Tips to help your child tolerate textured food

To make the gag reflex less sensitive and help children tolerate food in their mouth that is not smooth, you can try the following:

• Try to get your baby to relax during feedings and don’t push him to eat more than he’s inclined to. If he’s bottle-fed, make sure the hole in the nipple is the right size. If it’s too large, too much milk or formula may come at him at once.
• Add texture to the food, but still keep it all the same texture. That is, you can make the food more grainy but with no lumps. You can do this by taking the smooth food that the child likes to eat and adding something like wheat germ or graham cookie crumbs. This will make the food less smooth, but there will be no surprise lumps. You can start off by adding only a very small amount of the wheat germ or graham cookie crumbs. As the child improves, you can add more. This will help the child slowly get used to the feeling of texture in their mouth and throat. If your baby pushes the food out with his tongue, it doesn’t necessarily mean that he doesn’t like it — he’s probably just trying to figure out this new way of eating. Feed him slowly while he gets the hang of it.
• Also make sure he’s ready for solids before you introduce them. He should be at least 4 to 6 months old and able to sit upright with support. When you think your baby’s ready, start by putting a small amount of food on a spoon. Tip the spoon and place a bit of the food on the front of his tongue, rather than putting the whole spoonful in his mouth. This way, your baby can suck the rest of the food off the spoon without feeling it at the back of his throat right away.
• If your child is able, allow them to feed themselves for all or part of the meal. Children with sensitive gags often do better if they can feed themselves.
• Even if your child is not able to tolerate lumpy or textured pureed foods, they may be ready to try solids that dissolve easily, such as baby crackers or cookies. Children with sensitive gag reflexes often do better with solids that dissolve easily, rather than lumpy pureed foods.
• Brushing your child’s teeth will also often help to make their gag less sensitive.
• If your child enjoys putting toys in their mouth, provide teething toys that have bumps and different textures.

If your child continues to have trouble swallowing textured foods, speak to your child’s doctor.

Nasal congestion during pregnancy

Stuffy nose or nasal congestion during pregnancy is also known as pregnancy rhinitis where the symptoms of pregnancy rhinitis are similar to those of allergic rhinitis (‘hay fever’) and include a runny, itchy or congested nose, sneezing and watery eyes. While it might feel like you are getting a cold, pregnancy rhinitis is not associated with bacterial or viral infection and is therefore not contagious.

Stuffy nose or nasal congestion during pregnancy is caused by increased pregnancy hormones and blood in your body that make the lining of your nose swell, dry out and bleed.

Many pregnant women know the feeling of a stuffy nose, itchy eyes and post-nasal drip that seem to come out of nowhere during pregnancy. While it’s not a life-threatening medical condition, pregnancy rhinitis can be very troublesome — so what can you do to find some relief?

Here’s what you can do if you have or want to prevent a stuffy or runny nose or nosebleed:

• Use a humidifier to increase the moisture in the air in your home.
• Drink plenty of water.
• Put a few dabs of petroleum jelly on the insides of your nose.
• Use saline nose drops or nose rinse. Don’t use any other kind of medicine without talking to your provider first.

If you have a nosebleed:

• Sit up straight and lean forward.
• Breathe through your mouth and pinch your nose shut for 5 to 10 minutes with your thumb and finger.
• If you get blood in your mouth, spit it out. Swallowing it may upset your stomach.

How long will my ‘stuffy’ nose last?

While pregnancy rhinitis can occur at any time during pregnancy, it is most common during the first trimester. Symptoms may last for at least 6 weeks, but the good news is they usually disappear within 2 weeks after your baby’s birth.

Does stuffy nose while pregnant affect my unborn baby?

Many women with pregnancy rhinitis deliver healthy babies. However, any condition that reduces a pregnant mother’s sleep has the potential to impact on her baby. Symptoms of pregnancy rhinitis are especially felt at night, making it difficult to fall asleep, causing women to wake up frequently through the night and be sleepy during the day. Breathing through the mouth due to a blocked nose may increase the likelihood of airway infections.

There are insufficient studies to fully understand the impact of these on the growth and development of unborn babies. If you are concerned about your sleep or breathing during pregnancy, speak to your doctor to find the best way to clear your breathing passages and get proper sleep.

What causes nasal congestion during pregnancy?

Rhinitis is an inflammation of the lining of the nose. Women who are affected by allergies are likely to also experience similar symptoms during pregnancy. In these circumstances, symptoms are triggered by one or more allergens that may be seasonal (such as, pollens, fungi or molds) or perennial, or year-round, such as dust mites, pets or cockroaches.

Rhinitis in pregnancy may also have a non-allergic origin. It’s not known exactly why rhinitis occurs more frequently in pregnancy, but some researchers suggest that the larger blood volume and hormonal influences increase the likelihood of rhinitis by 10 to 30%.

Smoking is associated with pregnancy rhinitis, and it’s never too late for pregnant women and their partners – to quit smoking.

How is nasal congestion during pregnancy diagnosed?

Pregnancy rhinitis should be distinguished from other conditions such as infections, and your doctor can do this during a routine visit. X-rays and blood tests are usually not required to diagnose pregnancy rhinitis.

Pregnancy rhinitis should not cause significant breathing problems. If you feel you can’t get enough air, your chest feels very tight, you are breathless or feel like you’re being suffocated it might be a sign of a medical problem.

How is nasal congestion during pregnancy treated?

If your pregnancy rhinitis is triggered by a known allergen, you can try and avoid or limit your exposure.

Nasal irrigation is a drug-free technique to clear out air-borne allergens and mucus from blocked nostrils.

Using sterile salt water (saline) and a squirt bottle, spray solution into one nostril and let it drain out of the other nostril. This can provide relief and is a good solution during pregnancy.

Persistent symptoms can be managed individually. For example, if you have itchy-watery eyes, there are certain eye drops that are approved for use during pregnancy. Similarly, specific nasal sprays and antihistamines can be used, but always check with your doctor or pharmacist before taking any medicine while pregnant.

Be cautious when seeking treatment

Many women use non-prescription, over-the-counter (OTC) decongestant sprays to open up their nasal passages. Know that these medicines don’t work for pregnancy rhinitis. These medicines may give you temporary relief. However, they may actually make your symptoms worse and lead to a complete nasal blockage.

Experts say you can breathe easy with these measures:

• Don’t use OTC nasal decongestants.
• Drink plenty of fluids.
• Increase the humidity levels in your home. Use a humidifier.
• Don’t use nasal irritants, such as cigarette smoke.
• Get moving. Regular, moderate-intensity exercise can reduce congestion. It can also help you sleep better. But first, check with your healthcare provider to see what exercises are safe for you.
• When you go to sleep, raise the head of your bed. For instance, use an extra pillow or a wedge.
• Ask your healthcare provider about using OTC nasal strips and saline sprays or drops.

The good news? Even if you don’t do anything, you can expect your stuffy nose to clear up soon after your baby is born. It often goes away within two weeks of childbirth.

How to get child to stop picking nose

Many kids have habits that can be downright annoying. Four of the most common are:

• Nose picking. Nose picking appears to be a habit that, although it usually begins in childhood, may actually linger into adulthood. If you find that hard to believe, consider that a 1995 study of adults found that 91% picked their noses regularly and about 8% of them reported that they eat what they pick.
  
• Nail biting. If nails chewed to the nub are familiar to you, you’re not alone. Nail biting or picking is one of the most common childhood habits. An estimated 30% to 60% of kids and teens chew on one or more fingernails. And, occasionally, a child may also bite his or her toenails. Boys and girls appear equally prone to the habit in earlier years; however, as they get older, boys are more likely to be nail biters.
• Hair twirling. If one of your kids is a hair twirler, odds are it’s your daughter. Most kids who twist, stroke, or pull their hair are girls. Hair twirling may appear in early childhood as a precursor to hair pulling, either with or without hair loss. But many hair twirlers and pullers stop as they get older. For those who don’t, simple behavior modification can help them break the habit. However, for those who start hair pulling as older kids or teens, the habit is harder to break and may be a sign of anxiety, depression, or obsessive-compulsive disorder (OCD).
• Thumb sucking. Kids’ preference for thumbs as the finger to suck is thought to be the result of the thumb coming into contact with the mouth during movements they made an infants. Some kids also suck their fingers, hands, or their entire fists in addition to, or instead of, their thumbs. Most thumb suckers are younger kids and up to half of 2- to 4-year-olds suck their thumbs. Many kids suck their thumbs to calm and comfort themselves. But frequent or intense thumb sucking beyond 4 to 5 years of age can cause problems, including dental issues (such as an overbite), thumb or finger infections, and being teased.
  

Although these habits may bother or even worry you, relax. In most cases, a habit is just a phase in the normal developmental process and is not cause for alarm. These habits usually go away by themselves.

Habits may develop as entertainment for a bored child or more commonly, as a coping mechanism to soothe an anxious child. The next time you see nail biting or hair twirling, try to recall if your child has recently had a stressful experience. If so, the behavior might be your child’s attempt to relieve tension, much as you would by working out at the gym. On the other hand, some kids engage in habits when they’re relaxed, such as before falling to sleep or quietly listening to music.

To help your child break a habit, use gentle reminders when your child does the habit. Praise your child when he doesn’t. Praise will go a long way towards stopping habits. For example, you can say, ‘That’s great. I can hear your words clearly when your fingers aren’t in your mouth’.

The good news is that most habits go away by themselves, usually by the time a child reaches school age, because the child no longer needs it or outgrows it. But if your child’s habit is getting in the way of everyday activities, has become embarrassing, or is even causing some harm, you might want to take action.

For example, sucking thumbs or fingers is normal and common. But your child might be sucking fingers all the time. If this is getting in the way of talking or eating, or your child is being teased by peers because of it, it could be time to break the habit.

Some tips for breaking habits:

• Gently remind your child about the habit. This approach can be used with kids as young as 3 or 4 to help increase awareness of the problem. For example, if your child sucks on a sleeve, you can say, ‘Please don’t chew on your sleeve – it’s a bit yucky’. Or “I don’t like it when you bite your nails. It doesn’t look nice. Could you try to stop doing that?” Most important, the next time you see the nail biting, don’t scold or lecture. Punishment, ridicule, or criticism could cause the behavior to increase.
• Involve your child in the process of breaking the habit. If your 5-year-old comes home crying from kindergarten because the other kids made fun of his thumb sucking, understand that this is a way of asking you for help. Parents can ask their kids what they think they could do to stop the habit or if they want to stop the habit. Come up with some ways to work on breaking the unwanted habit together.
• Try to encourage your child to do something else during idle times. For example, you could encourage your child to play with a toy that has moveable parts while watching television. Maybe try a hand game like ‘Incy Wincy Spider’.
• Try to find out why your child is doing the habit, and suggest an alternative. For example, when if your child is a nail-biter, instead of saying, “Don’t bite your nails,” try saying, “Let’s wiggle our fingers.” This will increase awareness of the habit and may serve as a reminder. To occupy your child’s attention, try providing a distraction, like helping you in the kitchen or working on a craft.
• Reward and praise self-control. For example, allow your little girl to use nail polish if she lets her nails grow. Or every time your son refrains from sucking his thumb, reinforce the positive behavior by praising him and giving him a sticker or other small prize.
• Be consistent in rewarding good behavior. If you fail to notice good behavior, it will disappear over time. The new, positive habit must be firmly established before the old one will disappear.
• Habits can come in pairs, like sucking a thumb and pulling hair. When you stop the thumb-sucking, the hair-pulling might also stop.

For the best success, it’s important that kids be motivated to break the habit. And because habits take time to develop, they’re also going to take time to be replaced by alternative behavior, so be patient.

What are habits?

A habit is a pattern of behavior that your child does over and over again, almost without thinking and your child doing it usually isn’t even aware of it. But while kids may be blissfully unaware of a habit, their parents aren’t so lucky. Often children’s habits might bother or frustrate you, but usually they’re nothing to worry about.

Children’s habits usually involve touching or fiddling with parts of their faces or bodies. Sometimes children are aware of their habits, and sometimes they aren’t.

And if your little one usually has one hand stuffed in the mouth and the other entwined in the hair, don’t be surprised: Habits tend to happen in clusters.

Some common habits in children are:

• sucking a finger, thumb or dummy
• biting or picking at nails
• twirling and pulling hair
• picking their nose or sores
• picking at their lips or the insides of their cheeks
• chewing objects like pencils and clothing
• grinding teeth.

However, some behavior might look like a habit but have a medical cause. For example, if a child suddenly starts pulling or hitting an ear and is also cranky, it might be because she has an ear infection or is teething.

Habit or tic?

Tics aren’t habits. Tics are muscle spasms that cause jerky movements that seem out of the child’s control. Examples include repeated blinking, face twitches, and arm or shoulder jerks. Sometimes tics are caused by conditions like Tourette syndrome or by stress.

A child might be able to stop a tic for a short time, but it will come back when the child stops thinking about it. If you feel a tic is distressing for your child, it’s best to seek help from a health care professional. Your doctor is always a good place to start.

When is a habit no longer just a habit?

In some cases, a habit is the result or the cause of a physical or psychological problem. For example, a nose-picker might be uncomfortable because there’s actually an object stuck in the nose. And the habits themselves can cause some medical complications, such as:

• nosebleeds in the nose picker
• ingrown or infected nails in the nail biter
• dental problems, such as malocclusion (the failure of the teeth in the upper and lower jaws to meet properly), or thumb or finger infections in the thumb sucker

A habit may no longer be a simple habit if it negatively affects a child’s social relationships or interferes with daily functioning.

Older kids who constantly suck their thumb might be experiencing significant stress or anxiety. If kids are the subject of teasing at school or have difficulty talking because they won’t take their thumbs out of their mouths, the behavior has gone beyond a simple habit. Kids who pull their hair out may have trichotillomania, a condition that results in hair loss. And habits that are in response to obsessive thoughts may be a sign of Obsessive-Compulsive Disorder (OCD).

However, most habits don’t cause any significant problems and tend to improve as kids get older. But if you’re concerned about your child’s habits, talk with your doctor.

What causes a habit?

Experts aren’t always sure what causes a habit, but do know that they’re learned behaviors that usually provide a positive outcome for the child.

Habits can be comforting for children. Sucking is a good example. As toddlers leave behind the baby stage, habits like thumb-sucking can be a way of soothing stress or anxiety.

Sometimes habits happen because children are bored. That is, the behavior is just how children entertain themselves. For example, children are actually more likely to bite their nails while watching TV or doing nothing at all than when they’re feeling anxious.

Sometimes habits start for practical reasons but keep going when the practical reasons have gone. For example, young children with colds often pick their noses to clear them. Children who keep nose picking even after they’ve learned to blow their noses probably have habits.

Some habits may be leftovers from infancy. In infants, thumb sucking is a common self-comfort behavior that has pleasurable associations with feedings and the end of hunger. So it may linger into childhood because of its positive associations.

Or perhaps the explanation for your child’s nail biting is in your mirror. Do you bite your nails? Studies suggest that nail biting may have a strong familial or genetic component.

Other kids engage in habits to attract attention or to manipulate their parents. If kids feel that their parents are ignoring them, they may engage in the annoying habit because they know that it will get a reaction from Mom or Dad.

You’re a role model for your child. If you see your child starting a habit, perhaps ask yourself whether it’s one of your own habits. For example, nail-biting might be passed on within a family.

NOTE: some toddlers seem to get comfort from some common but slightly unusual behavior, including body-rocking, head-rolling and head-banging. Most children stop this behavior by the time they’re five years old.

Toddler defiance

It is a toddler’s job to be defiant. There is now emerging epidemiological evidence that a substantial proportion of toddlers in the general population may be experiencing a significant opposition-defiance problem before 2 years of age ¹⁾. Many disruptive behaviors already are part of the behavioral repertoire of the child by the end of the second year of life ²⁾. The next 2 years of life also are often considered to be very important for children’s socio-emotional development ³⁾. This is the period in your child’s development when she or he begins to understand that she/he is separate from you and is naturally eager to seek out more independence and control over her/his world. The problem, of course, is that while their desire to be their own person is coming into full gear, toddlers have not yet mastered self control. They are still driven by their needs, wants, and impulses, not by logic and reason. For better or worse, toddlers’ most frustrating behaviors are usually quite normal and developmentally appropriate.

It’s important to keep in mind that some toddlers are simply, by nature, more likely to be defiant than others. Children whose emotional reactions are big and intense, as well as children who are more cautious and fearful, may be more oppositional than children who are easy going and flexible. They tend to have a more difficult time with change and therefore protest, especially at transition times (e.g., getting into the car seat, bedtime, or going to a new place), as these experiences can be quite stressful for them.

Even the best-behaved children can be difficult and challenging at times. But if your child or teenager has a frequent and persistent pattern of anger, irritability, arguing, defiance or vindictiveness toward you and other authority figures, he or she may have oppositional defiant disorder.

As a parent, you don’t have to go it alone in trying to manage a child with oppositional defiant disorder. Doctors, mental health professionals and child development experts can help.

Behavioral treatment of oppositional defiant disorder involves learning skills to help build positive family interactions and to manage problematic behaviors. Additional therapy, and possibly medications, may be needed to treat related mental health disorders.

Dealing with a defiant toddler

No two children or families are alike. Thinking about the following questions can help you adapt and apply the information and strategies below to your unique child and family.

• What does your child tend to be most oppositional about? What do these things have in common? Why do you think this is? How can this understanding help you help your child cope better?
• How do you respond when your child is being defiant? What works? What doesn’t? What can you learn from this?

How to respond to your toddler’s defiant behavior

Validate your child’s feelings

• “I know you don’t want to put your pajamas on. It’s hard to go from playtime to bedtime.”

Set the limit

• “But it’s time for sleep so you can grow big and strong.”

Offer a few choices (acceptable to you)

• “Do you want to put your PJs on before or after we read books?” You might also give your child a choice between two pairs of pajamas she wants to wear. Choices give children some control in positive ways and can reduce defiance.

Use humor

This is a great way to lighten up the moment. You might put your child’s PJ bottoms on your head, or see if they fit onto his favorite stuffed animal. Humor gives everyone a chance to cool off.

Encourage your child to use his imagination

For a child who refuses to go to bed: “Teddy is soooo tired. He wants you to cuddle with him to help him fall asleep.” Or, when a child refuses to clean up: “These cars want to go back in the basket with their friends. Let’s race to see who can get more cars in there the fastest!”

Enforce the limit without anger

If none of these strategies work, and your child is still digging in her heels, calmly and firmly implement the limit. “You can get into the car seat or I can put you in. You decide.” If she resists, then calmly but firmly (not angrily) pick her up and strap her in. In a soothing voice tell her you know that she hates getting in the car seat, but it keeps her safe—and that’s your number one job.

Help your child recover

Pay no attention to the tantrum. Just start talking about something totally unrelated: “Wow, look at that big doggie coming down the street.”

Ignoring the behaviors you want to eliminate is the fastest way to be rid of them

The exception to this rule is if your child is hurting himself or someone else—that is, hitting, slapping, punching, and so on. Then stop him from the aggressive behavior and calmly but sternly say, “No hitting. You can feel mad, but you cannot hit. Hitting hurts.”

Avoid giving in

If you give into tantrums, your child learns that if she pushes hard enough, she’ll get what she wants. This will also make it more difficult the next time you try to enforce a limit.

What is oppositional defiant disorder?

Oppositional defiant disorder is a pattern of disobedient, hostile, and defiant behavior toward authority figures. Oppositional defiant disorder is a childhood behavior problem.

Oppositional defiant disorder is more common in boys than in girls. Some studies have shown that it affects 20% of school-age children. However, most experts believe this figure is high due to changing definitions of normal childhood behavior. It may also possibly have racial, cultural, and gender biases.

Oppositional defiant disorder behavior typically starts by age 8. However, it may start as early as the preschool years. This disorder is thought to be caused by a combination of biological, psychological, and social factors.

A child with oppositional defiant disorder:

• Won’t do what people ask
• Actively does not follow adults’ requests
• Thinks that what she’s being asked to do is unreasonable
• Gets angry and aggressive about being asked to do things
• Angry and resentful of others
• Argues with adults
• Blames others for own mistakes
• Has few or no friends or has lost friends
• Is in constant trouble in school
• Loses temper
• Is spiteful or seeks revenge
• Is touchy or easily annoyed

Oppositional defiant disorder can vary in severity:

• Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers.
• Moderate. Some symptoms occur in at least two settings.
• Severe. Some symptoms occur in three or more settings.

For some children, symptoms may first be seen only at home, but with time extend to other settings, such as school and with friends.

All children are disobedient and cranky sometimes, especially if they’re tired, upset or frustrated. But a child with oppositional defiant disorder behaves like this a lot, and the oppositional defiant disorder behavior is so severe that the child has trouble doing ordinary, everyday things. Children with oppositional defiant disorder often have other difficulties like learning disabilities, attention deficit hyperactivity disorder, anxiety disorders, mood disorders or language impairment.

It’s normal to hope that your child will grow out of oppositional defiant disorder, but oppositional defiant disorder won’t go away by itself. Your child needs professional diagnosis and treatment early on. This will help your child develop the skills he needs to make and keep friends, get and keep a job, and build a support network later in life.

If you think your child might have oppositional defiant disorder, start by speaking with your doctor for a referral to a pediatrician, psychiatrist or psychologist. These health professionals can diagnose oppositional defiant disorder.

Oppositional defiant disorder causes

There’s no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and environmental factors, including:

• Genetics — a child’s natural disposition or temperament and possibly neurobiological differences in the way nerves and the brain function
• Environment — problems with parenting that may involve a lack of supervision, inconsistent or harsh discipline, or abuse or neglect

Risk factors for developing oppositional defiant disorder

It’s hard to say why children develop oppositional defiant disorder. Oppositional defiant disorder is a complex problem. It’s probably not because of any one thing. Possible risk factors for oppositional defiant disorder include:

• Temperament — a child who has a temperament that includes difficulty regulating emotions, such as being highly emotionally reactive to situations or having trouble tolerating frustration
• Parenting issues — a child who experiences abuse or neglect, harsh or inconsistent discipline, or a lack of parental supervision
• The relationship between children and parents – for example, if children and parents haven’t been able to bond or respond to each other in consistently loving ways
• Other family issues — a child who lives with parent or family discord or has a parent with a mental health or substance use disorder
• Low academic performance at school – for example, if children have learning difficulties
• Speech and language problems in everyday life
• Poor social skills, poor problem-solving skills and memory problems
• Parenting and family factors – for example, inconsistent and harsh discipline, and a lot of family stress
• School environmental factors – for example, schools with harsh punishment or unclear rules, expectations and consequences
• Community factors – for example, negative influences from peers, neighborhood violence and a lack of positive things to do with free time.
• Environment — oppositional and defiant behaviors can be strengthened and reinforced through attention from peers and inconsistent discipline from other authority figures, such as teachers

Oppositional defiant disorder symptoms

Sometimes it’s difficult to recognize the difference between a strong-willed or emotional child and one with oppositional defiant disorder. It’s normal to exhibit oppositional behavior at certain stages of a child’s development.

Signs of oppositional defiant disorder generally begin during preschool years. Sometimes oppositional defiant disorder may develop later, but almost always before the early teen years. These behaviors cause significant impairment with family, social activities, school and work.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing oppositional defiant disorder. The DSM-5 criteria include emotional and behavioral symptoms that last at least six months.

Angry and irritable mood:

• Often and easily loses temper
• Is frequently touchy and easily annoyed by others
• Is often angry and resentful

Argumentative and defiant behavior:

• Often argues with adults or people in authority
• Often actively defies or refuses to comply with adults’ requests or rules
• Often deliberately annoys or upsets people
• Often blames others for his or her mistakes or misbehavior

Vindictiveness:

• Is often spiteful or vindictive
• Has shown spiteful or vindictive behavior at least twice in the past six months

Oppositional defiant disorder prevention

There’s no guaranteed way to prevent oppositional defiant disorder. However, positive parenting and early treatment can help improve behavior and prevent the situation from getting worse. The earlier that oppositional defiant disorder can be managed, the better.

Be consistent about rules and consequences at home. Don’t make punishments too harsh or inconsistent.

Model the right behaviors for your child. Abuse and neglect increase the chances that this condition will occur.

Treatment can help restore your child’s self-esteem and rebuild a positive relationship between you and your child. Your child’s relationships with other important adults in his or her life — such as teachers and care providers — also will benefit from early treatment.

Oppositional defiant disorder possible complications

Children and teenagers with oppositional defiant disorder may have trouble at home with parents and siblings, in school with teachers, and at work with supervisors and other authority figures. Children with oppositional defiant disorder may struggle to make and keep friends and relationships.

In many cases, children with oppositional defiant disorder grow up to have conduct disorder as teenagers or adults. In some cases, children may grow up to have antisocial personality disorder.

Oppositional defiant disorder may lead to problems such as:

• Poor school and work performance
• Antisocial behavior
• Impulse control problems
• Substance use disorder
• Suicide

Many children and teens with oppositional defiant disorder also have other mental health disorders, such as:

• Attention-deficit/hyperactivity disorder (ADHD)
• Conduct disorder
• Depression
• Anxiety
• Learning and communication disorders

Treating these other mental health disorders may help improve oppositional defiant disorder symptoms. And it may be difficult to treat oppositional defiant disorder if these other disorders are not evaluated and treated appropriately.

Oppositional defiant disorder diagnosis

To determine whether your child has oppositional defiant disorder, the mental health professional will likely do a comprehensive psychological evaluation. Because oppositional defiant disorder often occurs along with other behavioral or mental health problems, symptoms of oppositional defiant disorder may be difficult to distinguish from those related to other problems.

Your child’s evaluation will likely include an assessment of:

• Overall health
• Frequency and intensity of behaviors
• Emotions and behavior across multiple settings and relationships
• Family situations and interactions
• Strategies that have been helpful — or not helpful — in managing problem behaviors
• Presence of other mental health, learning or communication disorders

To fit the oppositional defiant disorder diagnosis, the pattern must last for at least 6 months and must be more than normal childhood misbehavior.

The pattern of behaviors must be different from those of other children around the same age and developmental level. The behavior must lead to significant problems in school or social activities.

To be diagnosed with oppositional defiant disorder, a child must have constant angry and cranky moods, along with negative, defiant behavior that upsets other people. A child must also have at least four symptoms from the following list.

The child:

• loses his temper
• argues with adults
• actively refuses to do what adults ask and disobeys rules
• often deliberately annoys people
• often blames others for mistakes or challenging behavior
• is easily annoyed by others
• is often nasty or unkind.

A child with oppositional defiant disorder shows the symptoms:

• very often
• in a way that interferes with usual daily activities
• for at least six months.

Children with symptoms of this disorder should be evaluated by a psychiatrist or psychologist. In children and adolescents, the following conditions can cause similar behavior problems and should be considered as possibilities:

• Anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Bipolar disorder
• Depression
• Learning disorders
• Substance abuse disorders

Oppositional defiant disorder treatment

The best treatment for a child with oppositional defiant disorder is to talk with a mental health professional in individual and possibly family therapy. The parents should also learn how to manage the child’s behavior.

Treatment for oppositional defiant disorder primarily involves family-based interventions, but it may include other types of psychotherapy and training for your child — as well as for parents. Treatment often lasts several months or longer. It’s important to treat any co-occurring problems, such as a learning disorder, because they can create or worsen oppositional defiant disorder symptoms if left untreated.

Medications alone generally aren’t used for oppositional defiant disorder unless your child also has another mental health disorder. If your child has coexisting disorders, such as ADHD, anxiety, childhood psychosis or depression, medications may help improve these symptoms.

The cornerstones of treatment for oppositional defiant disorder usually include:

• Parent training. A mental health professional with experience treating oppositional defiant disorder may help you develop parenting skills that are more consistent, positive and less frustrating for you and your child. In some cases, your child may participate in this training with you, so everyone in your family develops shared goals for how to handle problems. Involving other authority figures, such as teachers, in the training may be an important part of treatment.
• Parent-child interaction therapy. During parent-child interaction therapy, a therapist coaches parents while they interact with their child. In one approach, the therapist sits behind a one-way mirror and, using an “ear bug” audio device, guides parents through strategies that reinforce their child’s positive behavior. As a result, parents learn more-effective parenting techniques, the quality of the parent-child relationship improves, and problem behaviors decrease.
• Individual and family therapy. Individual therapy for your child may help him or her learn to manage anger and express feelings in a healthier way. Family therapy may help improve your communication and relationships and help members of your family learn how to work together.
• Cognitive problem-solving training. This type of therapy is aimed at helping your child identify and change thought patterns that lead to behavior problems. Collaborative problem-solving — in which you and your child work together to come up with solutions that work for both of you — can help improve oppositional defiant disorder-related problems.
• Social skills training. Your child may also benefit from therapy that will help him or her be more flexible and learn how to interact more positively and effectively with peers.

As part of parent training, you may learn how to manage your child’s behavior by:

• Giving clear instructions and following through with appropriate consequences when needed
• Recognizing and praising your child’s good behaviors and positive characteristics to promote desired behaviors

Although some parenting techniques may seem like common sense, learning to use them consistently in the face of opposition isn’t easy, especially if there are other stressors at home. Learning these skills will require routine practice and patience.

Most important in treatment is for you to show consistent, unconditional love and acceptance of your child — even during difficult and disruptive situations. Don’t be too hard on yourself. This process can be tough for even the most patient parents.

How you can manage your child’s behavior at home

At home, you can begin chipping away at problem behaviors of oppositional defiant disorder by practicing these strategies:

• Recognize and use praise to encourage positive behaviors. Be as specific as possible, such as, “I really liked the way you helped pick up your toys tonight”.
• Providing rewards for positive behavior also may help, especially with younger children.
• Look at using a structured reward system like a reward chart. These work especially well for children aged 3-8 years.
• Give short, brief, direct and specific instructions – for example, ‘Would you like to do your homework now, or after the next TV show?’
• Model the behavior you want your child to have. Demonstrating appropriate interactions and modeling socially appropriate behavior can help your child improve social skills.
• Try to avoid using negative consequences, but follow up on uncooperative behavior straight away. So if your child doesn’t do what you ask, ask again and say, ‘This is the last time I am going to tell you’. If your child still doesn’t cooperate, be ready with a consequence like loss of privilege.
• Pick your battles and avoid power struggles. Almost everything can turn into a power struggle, if you let it.
• Set limits by giving clear and effective instructions and enforcing consistent reasonable consequences. Discuss setting these limits during times when you’re not confronting each other.
• Set up a routine by developing a consistent daily schedule for your child. Asking your child to help develop that routine may be beneficial.
• Build in time together by developing a consistent weekly schedule that involves you and your child spending time together.
• Work together with your partner or others in your household to ensure consistent and appropriate discipline procedures. Also enlist support from teachers, coaches and other adults who spend time with your child.
• Assign a household chore that’s essential and that won’t get done unless the child does it. Initially, it’s important to set your child up for success with tasks that are relatively easy to achieve and gradually blend in more important and challenging expectations. Give clear, easy-to-follow instructions.
• Be prepared for challenges early on. At first, your child probably won’t be cooperative or appreciate your changed response to his or her behavior. Expect behavior to temporarily worsen in the face of new expectations. Remaining consistent in the face of increasingly challenging behavior is the key to success at this early stage.

Your child needs to know that she’s important to you. One of the best ways you can send this message is by spending positive time together doing things your child enjoys. This will help to strengthen your relationship with your child.

With perseverance and consistency, the initial hard work often pays off with improved behavior and relationships.

Working with your child’s school on oppositional defiant disorder

You can work with your child’s school to improve your child’s classroom and playground behavior. For example, you could talk to staff about:

• classroom behavior management programs – for example, seating your child at the front of the classroom away from distractions
• structured classroom activities – for example, having a daily planner on the wall that everyone can see and telling children when activities are about to change
• alternative thinking strategies – for example, allowing children to offer their own ideas about ways to solve problems
• emotional regulation programs that teach children how to manage strong emotions like anger and frustration
• resilience, wellbeing and bullying intervention programs
• rewards for good behavior, so that your child doesn’t feel that he’s always being punished for unacceptable behavior.

Looking after yourself when your child has oppositional defiant disorder

It can be challenging to balance looking after yourself with looking after your child with oppositional defiant disorder and other children in the family.

Here are some tips on how you can care for yourself:

• Make some time every day to be on your own to read a book, watch a TV show or go for a walk. Start with five minutes at the end of the day if that’s all you have.
• Ask family, friends or members of your support network to look after your child for a little while so you can have some time to yourself.
• Make time for some physical activity – for example, walking, yoga or swimming. A bit of exercise can give you more energy to work with your child.
• Make some time to do fun activities with your partner. Your child’s difficult behavior can be stressful on your relationship, especially if you and your partner don’t agree about how to handle your child’s behavior.
• Seek professional help from a doctor or counselor if you feel you can’t cope.

Sharing support, advice and experiences with other parents can be a big help. You could try starting a conversation in an online forum or joining a parent support group.

Behavior management plans for oppositional defiant disorder

Managing oppositional defiant disorder in children is about first accepting that your child will behave in challenging ways.

The next step is working with health professionals to develop a behavior management plan, which can make the behavior easier to handle – for you and your child.

A good plan will help your child:

• learn how to improve her behavior and understand how it affects other people
• manage strong emotions like anger and anxiety
• improve the way she solves problems, communicates and gets on with other children.

These things will help your child with making and keeping friends, saying what he thinks without getting angry, accepting no for an answer and playing well with others.

A good behavior management plan will also help you cope with your child’s challenging behavior by helping you:

• understand the causes of your child’s behavior
• work out how you can increase your child’s positive behavior and manage her challenging behavior
• support your child in managing strong emotions and improving social skills
• work on strengthening your family relationships.

Oppositional defiant disorder prognosis

Some children respond well to treatment, while others do not.

Whiny kids

Many children have difficulty regulating and express their emotions (anger and frustration) in words. Tantrums, outbursts, whining, defiance and fighting are all behaviors you see when kids experience powerful feelings they can’t control. They are a normal part of child development and most frequently occur in kids between the ages of 2 and 3. Whining and mood swings are just part of growing up. Whining and mood swings are signs of the emotional changes taking place as your child struggles to take control of actions, impulses, feelings, and his body. At this age, your child wants to explore the world and seek adventure. As a result, he’ll spend most of his time testing limits—his own, yours, and his environment’s. Unfortunately, he still lacks many of the skills required for the safe accomplishment of everything he needs to do, and he often will need you to protect him.

Whining can wear you down. Whining can even put you in embarrassing situations – for example, ‘Why can’t we buy that toy?’ It can be hard to say no when you know that giving in will bring your child instant pleasure or bring you instant relief from repeated requests, whingeing or temper tantrums.

But if you give in, your child learns that whining works. And this means he’ll keep whining.

When he oversteps a limit and is pulled back, he often reacts with anger and frustration, possibly with a temper tantrum or sullen rage. He may even strike back by hitting, biting, or kicking. At this age, he just doesn’t have much control over his emotional impulses, so his anger and frustration tend to erupt suddenly in the form of crying, hitting, or screaming. It’s his only way of dealing with the difficult realities of life. He may even act out in ways that unintentionally harm himself or others. It’s all part of being two.

Have sitters or relatives ever told you that your child never behaves badly when they’re caring for him? It’s not uncommon for toddlers to be angels when you’re not around, because they don’t trust these other people enough to test their limits. But with you, your toddler will be willing to try things that may be dangerous or difficult, because he knows you’ll rescue him if he gets into trouble.

Whatever protest pattern he has developed around the end of his first year probably will persist for some time. For instance, when you’re about to leave him with a sitter, he may become angry and throw a tantrum in anticipation of the separation. Or he may whimper, or whine and cling to you. Or he simply could become subdued and silent. Whatever his behavior, try not to overreact by scolding or punishing him. The best tactic is to reassure him before you leave that you will be back and, when you return, to praise him for being so patient while you were gone. Take solace in the fact that separations should be much easier by the time he’s three years old.

The more confident and secure your two-year-old feels, the more independent and well behaved he’s likely to be. You can help him develop these positive feelings by encouraging him to behave more maturely. To do this, consistently set reasonable limits that allow him to explore and exercise his curiosity, but that draw the line at dangerous or antisocial behavior. With these guidelines, he’ll begin to sense what’s acceptable and what’s not. To repeat, the key is consistency. Praise him every time he plays well with another child, or whenever he feeds, dresses, or undresses himself without your help, or when you help him to start with the activity and he completes it by himself. As you do, he’ll start to feel good about these accomplishments and himself. With his self-esteem on the rise, he’ll also develop an image of himself as someone who behaves a certain way—the way that you have encouraged—and negative behavior will fade.

Since two-year-olds normally express a broad range of emotions, be prepared for everything from delight to rage. If you’re struggling to handle your toddler’s behavior or if nothing seems to work, talk to your doctor. However, you should consult your pediatrician if your child seems very passive or withdrawn, perpetually sad, or highly demanding and unsatisfied most of the time. These could be signs of depression, caused either by some kind of hidden stress or biological problems. If your doctor suspects depression, she’ll probably refer your child to a mental health professional for a consultation.

Why do kids whine?

Children ask for things all the time – it’s a natural part of growing up and learning about the exciting world around them. But when your child keeps asking for something repeatedly even after you’ve said ‘no’, it’s whining. Whining can wear you down. It’s hard to stand your ground, especially in a public place like a supermarket.

To your child, the world is full of interesting things. In shopping centers, they’re often at your child’s eye level. Children are also easily influenced by clever marketing of children’s products – for example, toys and unhealthy food. And it can be hard for children to understand that some pretty, shiny or yummy things aren’t good for them or are a waste of money.

All of this can lead to whining – ‘Can I have a lolly?’, ‘I want a toy!’, ‘Please, please, please!’

Most children pester their parents for things they can’t have, like junk food at the supermarket or toys in a shopping center. In fact, ‘pester power’ is an important marketing tool for manufacturers. Advertising on children’s television and placing products in view of young children in the shops is a proven way of increasing sales because children pester their parents to buy them. Parents giving into their children’s whining is one of the causes of child overweight and obesity in the US.

Whining is very common. One survey found children in Australia ask their parents for something in the supermarket once every three minutes, on average. Parents give in and say yes more than 50% of the time.

In toddlers, being told ‘no’ can lead to whingeing or tantrums. That’s because at this age the disappointment can be too much for a child to bear. But it’s important not to give in, as that will teach your child that pestering works and make them more likely to pester in future.

How to prevent whining

Children are more likely to whine if they know it will work. The key to preventing whining is consistency. If you are consistent, your child knows you mean what you say and will be less likely to ask again. If you are inconsistent, your child knows there is a chance they will get what they want, so they will keep pushing.

Before you go to the shops, lay down some ground rules and tell your child what behavior you expect. Praise their good behavior and offer a healthy reward, like a play in the park, if they can get through the trip without asking you for something.

Try not to say ‘no’ too often. If you only say ‘no’ to things that really matter, your child will be more likely to listen.

It can also help to protect your child from advertising, both in the home and through product placement at the shops. The more they see these products, the more they will want them. Distract them or offer them an alternative.

Encouraging good behavior

It is up to you to model good behavior for your toddler. That means being honest with your child, listening to their point of view, and keeping your word. Try not to change your mind when you have offered a reward or a consequence – remember, consistency is the key.

Use simple instructions so your child understands, pick your battles, and don’t lose your sense of humor.

How to deal with toddler whining

Whining can be particularly stressful when it leads to a tantrum in a public place. Don’t be tempted to give in because there are strangers watching. Stay calm and forget your audience. It’s likely that most will be watching with empathy, and that they’ve probably been through it too!

Parents can start by helping children understand how their emotions work. Kids don’t go from calm to sobbing on the floor in an instant. That emotion built over time, like a wave. Kids can learn control by noticing and labeling their feelings earlier, before the wave gets too big to handle.

Some kids are hesitant to acknowledge negative emotions. A lot of kids are growing up thinking anxiety, anger, sadness are bad emotions. But naming and accepting these emotions is a foundation to problem-solving how to manage them.

Parents may also minimize negative feelings, because they want their kids to be happy. But children need to learn that we all have a range of feelings. You don’t want to create a dynamic that only happy is good.

Stay calm, manage your temper by breathing slowly and counting to 10, and use these techniques to help you cope.

When your child asks for something, make sure they use their manners. Don’t give in to threats, demands or whining and never give them something unless they ask for it nicely.

You do not have to say ‘no’ to everything your child asks for. Listen to your child’s request, praise them for asking politely, and take a moment to consider it. If you don’t want them to have something, explain the reasons why.

Even if they ask nicely, the answer might still be ‘no’. For example, you might not want them to eat a certain food, or you might not be able to afford the toy they want. It is important that your child understands that ‘no’ means ‘no’.

Don’t say ‘no’ unless you mean it. If you say ‘no’, stick to it. Try to distract your child from asking again with a new activity, a game or a trip somewhere else. A bath, music or a story can help to calm down the situation.

If the whining turns into a full-blown tantrum, stay calm, ignore the behavior and move away – but stay within sight so your toddler doesn’t feel abandoned. If you are in a public place, you can pick up your child and take them to a quiet, safe place to calm down.

When they are calm, give them a cuddle and talk about it. But make it clear they still cannot have the thing they want.

Reducing whining

You can take steps to make whining less likely to happen in the first place:

• Lay down some ground rules before you go shopping. Talk with your child about what behavior you expect and how you’ll respond to any whining.
• One of the best ways to teach your preschooler anything is to show him by example. If you speak in a calm, patient voice around your child, he’ll be more inclined to do the same. So try to think about the voice you use not only when talking to your child, but also whenever he can overhear you talking to others.
• Praise your child for good shopping behavior. Give her lots of positive attention so she knows you’ve noticed she’s not whining. For example, ‘I’m really proud of how you helped me shop and didn’t ask for things we can’t get’.
• Offer healthy rewards for good shopping behavior. For example, ‘If you can get through this shopping trip without asking for stuff, we’ll stop at the park on the way home’.
• Be aware of advertising in your home – for example, through the TV, radio, internet, junk mail, apps and social media. The more product advertising your child sees, the more he’ll want those products.
• Talk with your child about advertising and smart shopping. For example, you could talk about how free toys might make you want to buy some fast food products.
• Make decisions as a family about what you’ll buy. You can remind children of these decisions when you’re shopping. For example, ‘Remember we decided not to buy soft drink for a while? That way we’re all taking better care of our teeth’.

Handling whining

If your child pesters or tries to get you to buy things by whining, demanding or threatening, you could try the following:

• Remind your child of the ground rules you discussed.
• Let your child know you won’t consider the request until she uses her manners. For example, you could say, ‘Dani, use your nice voice’ or ‘Think about how you’re asking that question’.
• Don’t say yes or no until you’re happy with the way you’ve been asked.
• Make sure your child sees that you’ve heard and understood. This way, your child will be more likely to accept your answer. For example, you could say, ‘Yes, they do look delicious’.
• When you say no, stick to it. Giving in to whining can teach children to do it more. If you say no and then give in, your child gets the message that whining and whining can work.
• Acknowledge your child’s disappointment if you’ve said no. For example, ‘I can see you really wanted those biscuits. But we’ve already had enough treats today’. Conversations like these send a message of empathy and can help you and your child move on.
• After saying no, try to distract your child with something else. For example, ‘We need oranges. Can you help me find them?’

Define whining

Make sure your child knows what you’re talking about when you ask him to stop whining. Label whining when you hear it, and ask your child to use his normal voice instead. Explain that whining can sound annoying, and makes people stop listening. If he has trouble hearing the difference between a whine and a normal voice, show him using role-play.

You could also use dolls to role-play a conversation between a whiny child and his parent, or act it out together, taking turns to play each part. Hearing you at your whiniest will at least make your child laugh! And it’ll make him think about the tone of voice he uses, too.

Acknowledge your child’s need for attention

Your preschooler may resort to whining if he feels that he’s failed to get your attention by speaking normally. That’s why you’ll often hear him whine when you’re trying to talk to a friend, do your shopping list, or finish off that important bit of work.

Whenever your child asks for something nicely respond to him as soon as you can, even if you’re busy. You don’t have to drop everything and do what he wants, but you can acknowledge him and let him know you’ll be available soon. Make eye contact, tell him that you’ve heard him and thank him for asking so nicely.

Try coming up with a sign that your preschooler can use when he wants your attention, but you’re talking to someone else. For example, he could put his hand on your arm. Then, you could cover his hand with yours to let him know that you’re aware that he’s waiting. If he knows that you will be with him soon, he may be able to stay quieter while he waits.

A good rule of thumb is that your child may not be able to wait for more minutes than his age. For example, if he’s three, he’s likely to find it difficult to wait for anything for more than three minutes. So don’t ask him to wait too long. And if he waits patiently, be sure to give him lots of praise.

Talk about his feelings

Your preschooler may whine because he can’t fully express his feelings yet. You can help him to identify and name his emotions. For example, you could say, “I can see that you’re feeling upset. Is it because I can’t take you to the park this afternoon?” This will help you to start a conversation about what he needs.

Try filling your child’s request once

A whining child does indeed need your attention for at least a moment or two. At first, you won’t really know whether getting the thing he asks for will help him feel connected and capable again, or not. His request may seem reasonable to you—a drink of water, help with his shoes, one more turn listening to his favorite music. If giving him the thing he wants makes sense to you, go ahead and try it once. But if more whining follows, you can be sure that the real problem is his emotional “weather.” A storm is coming.

If he’s not satisfied, offer closeness and a clear limit

The cold tone that most of us use when we say, “No,” serves to make a child feel even more alone and adrift in an uncaring world. It deepens the rut your child is whining in.

If you can say, “Nope, no more cookies! Maybe tomorrow!” with a big grin and a kiss on the cheek, your child receives contact from you in place of cookies. If he whines some more, you can come back and say, “Nah, nah, nah, nah!” and nuzzle into his neck, ending with a little kiss. If he persists, bring him still more affection, “I’m your chocolate chip cookie! I’m all yours!” with a big grin. Then throw your arms around him and scoop him up. At some point, the affection you’re offering will tip him toward either laughter or a tantrum.

Both results, as odd as it may seem, are great for him. Laughter, tears, and tantrums help dissolve that shell of separateness that can enclose a child, as long as you listen and care. After a good cry (you listen, and keep sweetly saying, “No, James, no more cookies,” until he’s finished crying), or a good tantrum (“Yes, you really want one, I know, son”), or a good laugh (“I’m coming to give you big cookie kisses!”), he will feel your love for him again.

If you can’t be playful, be attentive

Playful moments don’t come easily to you when your children whine. So if you can’t find a way to nuzzle your child or respond with humor to his whiny requests, it will work well to come close and keep saying, with as little irritation as you can manage, “No,” “You need to wait,” “I can’t let you do that,” “He’s playing with it now,” or “You’ll get a turn, but not yet.”

Being very clear about the limit, and offering eye contact, a hand on his shoulder or knee, and whatever warmth you can muster, will help your child work himself into the cry or the tantrum or laughter he needs to do. Children know how to release feelings of upset. To get started, they just need us to pay attention to them long enough to communicate that we’ll stay with them through this rough patch.

Allow for laughter, tantrums, or tears for as long as you have time and patience

Children whine when lots of feelings have backed up inside them. When they finally break into a good wail or thrash, they may be working through more than the frustration of not getting the cookie or the red truck. They may be draining the tension from issues like having a younger brother or sister, having to say goodbye to you every morning, or having just gotten over an illness. In any case, children need to shed bad feelings until they don’t feel bad any longer.

If the pile of feelings is high, this can take some time. Parents don’t always have the time a child needs to finish the emotional task at hand. You may manage to listen to fifteen or twenty minutes of crying, and then feel the need to stop your child. If your child’s mood doesn’t improve, he wasn’t finished. It’s as hard for a child to have an unfinished cry as it is to be awakened in the middle of a nap. He’ll try to find a way to cry again soon. Something inside him knows that it will be good to finish the job. So listen again when you can. Your child will eventually finish his emotional episode, and make gains in confidence that both of you can enjoy.

Be consistent

Let your preschooler know that whining won’t get him what he wants, even if his demand is reasonable. Say something like, “I can’t understand you when you talk like that. Please use your normal voice, and I’ll be happy to listen.”

Even if you’re irritated, try to keep your voice level, and use a kind but firm tone. If your preschooler carries on whining, try a visual cue: turn away from your child when he whines. Then, when he repeats the question in a normal voice, turn towards him with a nod and a smile.

When your child does use his normal voice respond to him immediately, so that he learns that this voice is the one that works.

You don’t have to give him what he wants just because he asks without whining, though. Be sympathetic and appreciative: “I’m sorry but you can’t play now because it’s time for bed. Thank you for asking so nicely though!”

Avoid triggers

Feeling hungry, tired, thirsty or unwell may make your child grumpy and demanding. There are bound to be times when he just can’t help whining, and that’s understandable at his age. But it will help him if you can think ahead to situations that will make him whiny, and do your best to make them easier for him.

Taking him into the biscuit aisle of the supermarket before he’s had dinner is sure to trigger some frustrated whining! Give your child a small meal before you go out, or pack some healthy snacks he can eat on the way or in the shop. Try to avoid running errands or visiting friends at the end of the day, when he’s tired and ready to wind down.

Staying calm when children whine

Whining can be frustrating and annoying. If you feel that whining is getting the better of you, this exercise might help:

1. Stop.
2. Count to 10.
3. Now respond to your child.

That extra 10 seconds is often enough to calm you down.

The hard part about trying the experiments above is that whining triggers all kinds of irrational feelings inside of you. Whining kicks up feelings of resentment, exhaustion, and anger in parents.

You feel like you’re being manipulated. You feel helpless.

When your feelings surge, you don’t think logically either. You react, usually behaving the way your parents reacted to your whining. The reactions you have to whining have been passed down through the generations in your families, each generation usually doing a milder version than the generation before it.

So it takes some mental preparation to decide to move toward a whining child and offer connection, rather than placate him or punish him.

Every parent deserves someone to listen to how hard it can be to care for a child or children. So finding ways to be heard by another adult who won’t get worried or try to “fix” us is an important part of our job as parents.

Don’t give in

Do your best to be indifferent to your child’s whining, or at least pretend to be. If you’re tired and stressed yourself, you may feel like giving in just to make him stop. But you don’t want him to think that whining works, so stick to your principles and stay calm. The long-term gains will be well worth it.

Saying, “Oh, go ahead, do whatever you want!” may bring immediate relief from that annoying whinge. But you’ll hear a lot more whining in the future if your child thinks that it’s a reliable way to get what he wants. Staying firm will teach him that whining doesn’t work, and encourage him to find other ways to express his feelings.

If your child’s tantrums ever get physical, learn how to deal with aggression in preschoolers.

Toddler constantly crying

All children cry when they’re hungry, tired, uncomfortable, sick or in pain. Sometimes they cry because they need affection. Toddlers and older children might also cry because they’re frustrated, sad or angry, for example. But it can sometimes be hard to work out what your crying child needs, especially if she isn’t talking yet. So when your child cries, start by checking that he isn’t sick or hurt. If you’re not sure, make an appointment with your doctor.

If your child is crying for another reason, there are lots of things you can do to help. However, never shake, hit or hurt a crying child. If you feel like you might hurt your child, stop before you do anything. Walk away and take some deep breaths. Call someone for help.

Toddlers cry for the same reasons as babies. But toddlers also cry as a way of dealing with new and difficult emotions like frustration, embarrassment or jealousy.

Crying in babies and children is one of the most common reasons parents seek professional help. If your child is crying a lot, you might be feeling very low, or even depressed. If you feel like this or are having thoughts about hurting your child, it’s important to seek help straight away.

Sometimes it helps to have another person take over for a while. If you can, ask your partner to come home, or get a friend or relative to come over and help out.

How to manage your toddler’s crying

If your child is physically OK, the following tips might help:

• If you think your child might be tired, a rest might help. Or you could give her some quiet time listening to music or a story.
• If the crying happens at bedtime, you might need some help settling your child.
• If your child is angry or having a tantrum, take him somewhere safe to calm down.
• If your child is frustrated, try to work out a solution together. For example, ‘You’re frustrated because the blocks keep falling over. Let’s try again together’. Naming an emotion lets your child know that you understand her feelings. It also helps her learn self-regulation.
• If your toddler is just cranky, try a change of scenery like a walk outside, give him a bubble bath, or put on some kids’ music and dance around together. You might be surprised how much fun you have.

Preschoolers and school-age children crying

Children tend to cry less as they get older. Once your child can talk, it’s much easier for her to use words to tell you why she’s upset and what she needs. It’s also likely to be easier for you to talk with her about her feelings.

How to manage your preschooler’s or school-age child’s crying

If your child is physically OK, try the following ideas:

• Give your child a chance to calm down, then ask him what has made him so upset. Show you’re listening by repeating his feelings back to him. For example, ‘You’re feeling sad because Sam wouldn’t play with you’.
• Offer your child some other ways to deal with the situation. For example, ‘How about you ask to join in Jai’s game instead?’
• Make sure your child understands that sometimes it’s OK to cry – for example, when something sad happens or when she gets hurt. For example, ‘Ouch, I’d be crying too if I hit my head’.

If your child seems to spend a lot of time crying and acting sad, consider asking your doctor for advice.

Building resilience in children

Resiliency is the ability to ‘bounce back’ from a difficult situation. A resilient person is able to:

• withstand adversity
• learn from their experiences
• cope confidently with life’s challenges.

When psychologists talk about resilience, they’re talking about a child’s ability to cope with ups and downs, and bounce back from the challenges they experience during childhood – for example moving home, changing schools, studying for an exam or dealing with the death of a loved one. Building resilience helps children not only to deal with current difficulties that are a part of everyday life, but also to develop the basic skills and habits that will help them deal with challenges later in life, during adolescence and adulthood.

Resilience is important for children’s mental health. Children with greater resilience are better able to manage stress, which is a common response to difficult events. Stress is a risk factor for mental health conditions such as anxiety and depression, if the level of stress is severe or ongoing.

The question for parents then becomes, “How can I help my child become more resilient?”

Psychologists have identified some of the factors that make someone resilient. These include:

1. Having a positive attitude
2. Being optimistic
3. Having the ability to regulate emotions
4. Seeing failure as a form of helpful feedback.
5. Competence. It’s easy to assume that “competence” simply refers to a child’s mastery of school materials, but in reality, there are many other ways children can build up their feelings of competence. The key to helping children develop a feeling of competence is to give them opportunities to master specific skills or strengths. Luckily, there are plenty of opportunities for skill mastery both at school and at home. Start by giving your child a task that’s a challenge for them initially—assign a complicated chore, ask them to help with dinner and give them a dish to complete, or work with them as they try to master a set of spelling words. When they successfully complete the challenge, compliment them on their effort. Make sure you start small with challenges that your child can realistically accomplish at their stage of development. The sense of achievement they feel from successfully completing a challenge will convince them that they have the ability to meet new, harder challenges.
6. Confidence. At the Wisconsin School of Business at the University of Wisconsin, researchers found that higher confidence directly correlates with increased feelings of hope, efficacy, optimism and resilience. They discovered that confident students perform better in school and feel happier with their life. They’re also more likely to bounce back from challenges and overcome failure. Feeling confident is incredibly important to helping children develop a sense of resilience. When children feel confident, they are more likely to take on new tasks, expand their social circle, take risks—and try again if that risk doesn’t pan out. When they fail at a task, confident children are more likely to fault their tactic than to believe that a task is beyond their capabilities. To help your child develop confidence, focus on giving them specific praise that’s closely tied to their efforts, not their intelligence.
7. Connected to the people around them. Your sense of resilience is affected by the strength of your social connections. Resilient children often feel a strong bond with friends, siblings, parents and other family members, as well as teachers and other people in caregiver roles. They feel protected and believe that they can count on their network to be there for them if needed. You can help your child develop resilience by being there for them when they face setbacks. Often children feel discouraged when they’re not immediately good at something—such as kicking a soccer ball. Keep encouraging them to try again, recognize their progress and tell them about a time when you experienced a similar setback. Psychologists have found that sharing stories helps people feel more connected to each other, and talking over different approaches they could try next time will help your child feel that you’re invested in their success.
8. Secure in their character. Character isn’t something that parents teach or don’t teach—children are actually born with a rudimentary sense of morality. In fact, recent studies from Yale University’s Infant Cognition Center show that children as young as three months naturally show a strong preference for stuffed animals that act “nicely” over those who act “unkindly.” That means they naturally possess the instinct to do the “right” thing. As a parent, you should focus on helping your child develop their natural instincts into an internal moral compass. Sometimes children get confused about what is “right” and need guidance. Other times, selfish instincts still overtake them and they must be corrected. By teaching them standards they should follow, you can help your child feel confident they’ll know how to act in in different situations.
9. Personal contributions. If you talk to resilient people in different fields, they all have one thing in common: they believe their actions make a difference. The scientist believes that the time he put in at the lab directly contributed to a breakthrough discovery. The point guard knows the time she stopped a breakaway kept the other team from scoring and gave her team an opportunity to tie the game. You can help your child feel like a contributor by asking them about how their actions helped the group succeed. When children understand how and why their contributions matter, they invest more of themselves into an endeavor. They may play harder defense or ensure they are precise with their measurements. Even if something doesn’t work out, they know that their actions were important. They will push themselves to learn more and study harder, and they will develop more confidence as their work leads to more success.
10. Coping skills. A child may appear confident, but only until something doesn’t go according to plan—then they fall apart. A truly resilient child is one who is able to manage their emotions when they face adversity (so they can keep working towards their goal). Resilient children start by facing their feelings about the situation and contain any disappointment, frustration or anger. Then they start thinking about the challenge not as a dead end, but as a stumbling block they can overcome.
11. Healthy environment. A child’s environment is the final factor that has a big impact on how confident they feel. When children have consistent caregivers, a predictable routine and clear boundaries from the adults in their life, they feel less stress and are more connected to the people around them. This develops their ability to cope with challenges that arise.

Resilient teenagers are able to control their emotions in the face of challenges such as:

• physical illness
• change of schools
• transitioning from primary school to high school
• managing study workload and exams
• change in family make-up (separation and divorce)
• change of friendship group
• conflict with peers
• conflict with family
• loss and grief.

Resiliency can be taught through practising positive coping skills.

Success in life is never a simple path from A to B. Even if you do everything right, there will still be twists and turns along the way. The key to success is to view those bumps in the road as minor setbacks, not unsurmountable obstacles.

For someone to succeed, they need to have the resilience to bounce back from challenges and overcome failure.

We’ve found that resilient children have seven characteristics in common. The first step to helping your child become more resilient is recognizing which of these key traits your child already possesses. Then use that as a starting place to help your child develop the confidence to meet life’s challenges head-on.

Where does resilience come from?

Resilience is shaped partly by the individual characteristics you are born with (your genes, temperament and personality) and partly by the environment you grow up in — your family, community and the broader society. While there are some things we can’t change, such as your biological makeup, there are many things you can change.

One way of explaining the concept of resilience is to imagine a plane encountering turbulence mid-flight. The turbulence, or poor weather, represents adversity. Different planes will respond to poor weather conditions in different ways, in the same way different children respond to the same adversity in different ways.

The ability of the plane to get through the poor weather and reach its destination depends on:

• the pilot (the child)
• the co-pilot (the child’s family, friends, teachers and health professionals)
• the type of plane (the child’s individual characteristics such as age and temperament)
• the equipment available to the pilot, co-pilots and ground crew
• the severity and duration of the poor weather.

You can all help children become more resilient and the good news is, you don’t have to do it alone. You can ask other adults such as carers and grandparents to help. Building children’s resilience is everyone’s business, and it’s never too early or too late to get started. You’ve got some simple things that you can do in your own home.

Teaching children resilience

Latest research found that there are five areas that offer the best chance for building resilience in children.

As a parent you can help to develop essential skills, habits and attitudes for building resilience at home by helping your child to:

• build good relationships with others including adults and peers
• build their independence
• learn to identify, express and manage their emotions
• build their confidence by taking on personal challenges

There are some simple things you can do to build your child’s resilience in these areas. You might be able to think of more.

It’s important to remember that the strategies recommended:

• are suitable for everyday use with children aged 0–12 years
• have been tailored for pre-school aged children (1–5 years) and
• primary school aged children (6–12 years)
• should be prioritized in a way that best meets your child’s needs.

If your child is currently experiencing stress, challenges or hardships in life which are affecting their wellbeing, additional professional support may be necessary.

Figure 1. Building resilience in kids

Positive coping strategies

‘Coping’ describes any behavior that is designed to manage the stresses and overwhelming feelings that come with tough situations. By learning and developing positive coping skills in their teenage years, your child will build resilience and wellbeing and be set up with an important skill for life. It’s also important to understand the difference between positive and negative coping skills, and how these strategies can have very different long-term results.

Teaching coping skills to your teenager could be one of the most important skills they learn. They will help your teenager manage any obstacle that may get in the way of their endeavours.

Positive coping skills will help if:

• your child doesn’t cope well with stress
• your child often feels overwhelmed
• your child’s health and wellbeing are negatively impacted by stressful events and difficult emotions.

You can do some simple things to teach your child coping skills and help them put these skills into action. It’s never too early or too late to learn how to do this. It’s a good skill for life.

Talking it out

Encourage your child to speak up if they’re experiencing a tough time, by creating a safe space where their feelings won’t be judged. If what they’re going through doesn’t seem like a big deal to you, keep in mind that it’s very real for them, so be supportive and not dismissive.

It’s also important not to force your child to speak to you if they really don’t want to. Instead, let them know that you’re here to help, but if they’re not comfortable speaking to you (which is okay and shouldn’t be taken personally), encourage them to speak to someone else they trust, such as a friend or another family member.

Taking a break

Taking an active time-out from something that is causing distress is a great way to refocus thoughts and energy. If your child is having difficulty coping, let them know that taking it easy from time to time isn’t being lazy; it’s actually very healthy, especially if they’ve been experiencing a hard time.

Doing something they love

Engaging in enjoyable activities can help lower stress and put them in a positive mindset. Some examples might be:

• taking a walk or using an exercise app
• listening to music
• writing, drawing or painting
• watching a TV show, movie or TED talk
• playing a game online or joining a sports team
• FaceTiming, calling, texting or physically hanging out with friends.

There are heaps of apps out there that can help your teen do activities or learn something new from the comfort of their bedroom.

Eating well and exercising

It’s no myth that physical health has a big impact on mental health. Ensure that your child is eating healthy, nutritious meals that will help their body support them through tough times. Exercise can also help by releasing tension and increasing energy levels.

Try getting as many vegetables, fruits and whole grains into your family’s diet. This might be things like choosing a wholemeal or grainy bread at the supermarket and swapping the after school biscuits to a pieces of fruit. Just as simple, easy and cheap but better for your whole family.

Using relaxation techniques

Teach your child some relaxation techniques that can help with relieving stress.

Engaging in positive self-talk

Let your child know that it’s okay to feel good about, and even to compliment themselves on, all their achievements, however big or small. Start by letting them know why you think they’re great, and encourage them to talk about what they like about themselves. This can help to increase their positive mindset and motivation. Encourage them to be mindful of their achievements and skills (or even to write them down) as a regular reminder of their strengths.

Modeling positive coping behaviors

A really great way to encourage your child to develop positive coping skills is to model the behaviors yourself to show them what positive coping looks like.

Confide in your child about times when you’ve found it hard to cope, and share with them the positive strategies that have worked for you. This will not only make them feel less alone, but will also reinforce the importance of seeking help.

Self-talk

Even though you might not know it, you’re already practicing self-talk.

Self-talk is basically your inner voice, the voice in your mind that says the things you don’t necessarily say out loud. We often don’t even realise that this running commentary is going on in the background, but our self-talk can have a big influence on how we feel about who we are.

The difference between positive and negative self-talk

• Positive self-talk makes you feel good about yourself and the things that are going on in your life. It’s like having an optimistic voice in your head that always looks on the bright side. Examples: ‘I am doing the best I can’, ‘I can totally make it through this exam’, ‘I don’t feel great right now, but things could be worse’
• Negative self-talk makes you feel pretty crappy about yourself and the things that are going on. It can put a downer on anything, even something good. Examples: ‘I should be doing better’, ‘Everyone thinks I’m an idiot’, ‘Everything’s crap’, ‘Nothing’s ever going to get better.’

Negative self-talk tends to make people pretty miserable and can even impact on their recovery from mental health difficulties. But it’s not possible, or helpful, to be positive all the time, either. So, how can you make your self-talk work for you?

3 ways to talk yourself up

1. Listen to what you are saying to yourself
   • Notice what your inner voice is saying
   • Is your self-talk mostly positive or negative?
   • Each day, make notes on what you’re thinking
2. Challenge your self-talk
   • Is there any actual evidence for what I’m thinking?
   • What would I say if a friend were in a similar situation?
   • Can I do anything to change what I’m feeling bad about?
3. Change your self-talk
   • Make a list of the positive things about yourself
   • Instead of saying, “I’ll never be able to do this”, try “Is there anything I can do that will help me do this?”

Why should I practice?

The more you work on improving your self-talk, the easier you’ll find it. It’s kind of like practising an instrument or going to sports training: it won’t be easy to start with, but you’ll get better with time.

It might not seem like much, but self-talk is a huge part of our self-esteem and confidence. By working on replacing negative self-talk with more positive self-talk, you’re more likely to feel in control of stuff that’s going on in your life and to achieve your goals.

Problem-solving

Problem-solving is an important life skill for teenagers to learn. You can help your child develop this skill by using problem-solving at home.

Everybody needs to solve problems every day. But you’re not born with the skills you need to do this – you have to develop them.

By putting time and energy into developing your child’s problem-solving skills, you’re sending the message that you value your child’s input into decisions that affect her life. This can enhance your relationship with your child.

When solving problems, it’s good to be able to:

• listen and think calmly
• consider options and respect other people’s opinions and needs
• find constructive solutions, and sometimes work towards compromises.

These are skills for life – they’re highly valued in both social and work situations.

When teenagers learn skills and strategies for problem-solving and sorting out conflicts by themselves, they feel better about themselves. They’re more independent and better placed to make good decisions on their own.

Problem-solving steps

Often you can solve problems by talking and compromising. The following six steps for problem-solving are useful when you can’t find a solution. You can use them to work on most problems – both yours and your child’s.

If you show your child how these work at home, he’s more likely to use them with his own problems or conflicts with others. You can use the steps when you have to sort out a conflict between people, and when your child has a problem involving a difficult choice or decision.

This strategy works best when your child is feeling calm and relaxed. If they’re very anxious or angry, help them to calm down first (quiet time, take some deep breaths) or leave problem-solving for another day when they are feeling calmer.

1. Identify the problem

The first step in problem-solving is working out exactly what the problem is. This helps make sure you and your child understand the problem in the same way. Then put it into words that make it solvable. For example:

• ‘I noticed that the last two Saturdays when you went out, you didn’t call us to let us know where you were.’
• ‘You’ve been using other people’s things a lot without asking first.’
• ‘You’ve been invited to two birthday parties on the same day and you want to go to both.’
• ‘You have two big assignments due next Wednesday.’
• ‘You want to go to a party with your friends and come home in a taxi.’
• ‘I’m worried there will be a lot of kids drinking at the party, and you don’t know whether any adults will be present.’
• ‘When you’re out, I worry about where you are and want to know you’re OK. But we need to work out a way for you to be able to go out with your friends, and for me to feel comfortable that you’re safe.’

Focus on the issue, not on the emotion or the person. For example, try to avoid saying things like, ‘Why don’t you remember to call when you’re late? Don’t you care enough to let me know?’ Your child could feel attacked and get defensive, or feel frustrated because she doesn’t know how to fix the problem.

You can also head off defensiveness in your child by being reassuring. Perhaps say something like, ‘It’s important that you go out with your friends. We just need to find a way for you to go out and for us to feel you’re safe. I know we’ll be able to sort it out together’.

2. Think about why it’s a problem

Help your child describe what’s causing the problem and where it’s coming from. It might help to consider the answers to questions like these:

• Why is this so important to you?
• Why do you need this?
• What do you think might happen?
• What’s the worst thing that could happen?
• What’s upsetting you?

Try to listen without arguing or debating – this is your chance to really hear what’s going on with your child. Encourage him to use statements like ‘I need … I want … I feel …’, and try using these phrases yourself. Be open about the reasons for your concerns, and try to keep blame out of this step.

3. Brainstorm possible solutions to the problem

Make a list of all the possible ways you could solve the problem. You’re looking for a range of possibilities, both sensible and not so sensible. Try to avoid judging or debating these yet.

If your child has trouble coming up with solutions, start her off with some suggestions of your own. You could set the tone by making a crazy suggestion first – funny or extreme solutions can end up sparking more helpful options. Try to come up with at least five possible solutions together.

Write down all the possibilities.

4. Evaluate the solutions to the problem

Look at the solutions in turn, talking about the positives and negatives of each one. Consider the pros before the cons – this way, no-one will feel that their suggestions are being criticised.

After making a list of the pros and cons, cross off the options where the negatives clearly outweigh the positives. Now rate each solution from 0 (not good) to 10 (very good). This will help you sort out the most promising solutions.

The solution you choose should be one that you can put into practice and that will solve the problem.

If you haven’t been able to find one that looks promising, go back to step 3 and look for some different solutions. It might help to talk to other people, like other family members, to get a fresh range of ideas.

Sometimes you might not be able to find a solution that makes you both happy. But by compromising, you should be able to find a solution you can both live with.

5. Put the solution into action

Once you’ve agreed on a solution, plan exactly how it will work. It can help to do this in writing, and to include the following points:

• Who will do what?
• When will they do it?
• What’s needed to put the solution into action?

You could also talk about when you’ll meet again to look at how the solution is working.

Your child might need some role-playing or coaching to feel confident with his solution. For example, if he’s going to try to resolve a fight with a friend, he might find it helpful to practice what he’s going to say with you.

6. Evaluate the outcome of your problem-solving process

Once your child has put the plan into action, you need to check how it went and help her to go through the process again if she needs to.

Remember that you’ll need to give the solution time to work, and note that not all solutions will work. Sometimes you’ll need to try more than one solution. Part of effective problem-solving is being able to adapt when things don’t go as well as expected.

Ask your child the following questions:

• What has worked well?
• What hasn’t worked so well?
• What could you or we do differently to make the solution work more smoothly?

If the solution hasn’t worked, go back to step 1 of this problem-solving process and start again. Perhaps the problem wasn’t what you thought it was, or the solutions weren’t quite right.

When conflict is the problem

During adolescence, you might clash with your child more often than you did in the past. You might disagree about a range of issues, especially your child’s need to develop independence.

It can be hard to let go of your authority and let your child have more say in decision-making. But she needs to do this as part of her journey towards being a responsible young adult.

You can use the same problem-solving steps to handle conflict. When you use these steps for conflict, it can reduce the likelihood of future conflict.

Let’s imagine that you and your child are in conflict over a party at the weekend.

You want to:

• take and pick up your child
• check that an adult will be supervising
• have your child home by 11 pm.

Your child wants to:

• go with friends
• come home in a taxi
• come home when she’s ready.

How do you reach an agreement that allows both of you to get some of what you want?

The problem-solving strategy described above can be used for these types of conflicts. It follows these steps:

1. Identify the problem

Put the problem into words that make it workable. For example:

• ‘You want to go to a party with your friends and come home in a taxi.’
• ‘I’m worried there will be a lot of kids drinking at the party, and you don’t know whether any adults will be present.’
• ‘When you’re out, I worry about where you are and want to know you’re OK. But we need to work out a way for you to be able to go out with your friends, and for me to feel comfortable that you’re safe.’

2. Think about why it’s a problem

Find out what’s important for your child and explain what’s important from your perspective. For example, you might ask, ‘Why don’t you want to agree on a specific time to be home?’ Then listen to your child’s point of view.

3. Brainstorm possible solutions

Be creative and aim for at least four solutions each. For example, you might suggest picking your child up, but he can suggest what time it will happen. Or your child might say, ‘How about I share a taxi home with two friends who live nearby?’

4. Evaluate the solutions

Look at the pros and cons of each solution, starting with the pros. It might be helpful to start by crossing off any solutions that aren’t acceptable to either of you. For example, you might both agree that your child taking a taxi home alone is not a good idea.

You might prefer to have some clear rules about time – for example, your child must be home by 11 pm unless otherwise negotiated.

Be prepared with a back-up plan in case something goes wrong, like if the designated driver is drunk or not ready to leave. Discuss the back-up plan with your child.

5. Put the solution into action

Once you’ve reached a compromise and have a plan of action, you need to make the terms of the agreement clear. It can help to do this in writing, including notes on who will do what, when and how.

6. Evaluate the outcome

After trying the solution, make time to ask yourselves whether it worked and whether the agreement was fair.

Managing emotions

Primary school kids are still learning to identify emotions, understand why they happen, and how to manage them. As children develop the things that provoke emotional responses change, as do the strategies they use to deal with them.

Some children show a high level of emotional maturity while quite young, whereas others take longer to develop the skills to manage their emotions. This is really normal – everyone develops at different stages and paces.

All children need support from their parents and caregivers to understand their feelings, as well as encouragement to work out ways to manage them – some might just need a bit of extra help to figure things out.

If your child is showing signs of emotional or behavioral difficulties it’s important to seek help early and address any problems before they get worse. Getting support for yourself, through family and friendship networks or your doctor, is also very important. This support helps to build your own resilience, so you can care for your kids.

Understanding your child’s feelings

Supporting children’s emotional development starts with paying attention to their feelings and noticing how they manage them. By acknowledging children’s emotional responses and providing guidance, you can help kids understand and accept feelings, and develop effective strategies for managing them.

• Tune in to children’s feelings and emotions. Some emotions are easily identified, while others are less obvious. Tuning into children’s emotions involves looking at their body language, listening to what they’re saying and how they’re saying it, and observing their behavior. Figuring out what they’re feeling and why means you can respond more effectively to their needs, and help them develop specific strategies – for example, when we’re feeling nervous, we can try taking big deep breaths.
• Validate your child’s emotional experiences. Listen to what children say and acknowledge their feelings. This helps children to identify emotions and understand how they work. Being supported in this way helps children work out how to manage their emotions. You might say, “You look worried. Is something bothering you?” or “It sounds like you’re really angry. Let’s talk about it.”
• Set limits in a supportive way. Kids need to understand that having a range of emotions and feelings is OK, but there are limits to how feelings should be expressed appropriately. You can set limits, talk about why these exist, and how one person’s feelings shouldn’t make someone else feel upset. For example, “I know you’re upset that your friend couldn’t come over, but that doesn’t make it OK to yell at me.”
• View emotions as an opportunity for connecting and teaching. Children’s emotional reactions provide ‘teachable moments’ for helping them understand emotions and learn effective ways to manage them. You might say, “I can see you’re really frustrated about having to wait for what you want. Why don’t we read a story while we’re waiting?”
• Be a role model. Children learn about emotions and how to express them appropriately by watching others – especially parents and other family members. Showing kids the ways you understand and manage emotions helps them learn from your example. If you lose your temper (hey, it happens!), apologize and show how you might make amends.
• Encourage problem-solving. Help children develop their skills for managing emotions by encouraging them think of different ways they could respond. You might say, “What would help you feel brave?” or “How else could you look at this?”
• Providing security. Kids are reassured by knowing that a responsible adult is taking care of them and looking after their needs. Parents and other family members can help children manage their emotions by creating a safe and secure environment. Kids need extra support from you when they’re feeling tired, hungry, sad, scared, nervous, excited or frustrated. Regular routines, such as bedtimes and mealtimes, reduce the impact of stress and helps to provide a sense of stability for kids.

Dealing with difficult emotions

Modelling behavior when you’re feeling stressed or upset helps kids develop their own strategies for coping with their emotions.

You can say:

• “I’m getting too angry. I need some time out to think about this.”
• “I’m feeling really tense. I need to take some deep breaths to calm down.”

Being ready to apologize, listening to how the other person feels and showing you appreciate their position is a critical skill for building strong and supportive family relationships.

Admitting to having difficult feelings is not a sign of weakness or failure. Instead, it sets a good example by showing that everyone has difficult feelings at times and that they are manageable.

Dealing with stress

Every child is an individual and will approach life and its challenges in completely different ways. By paying attention and listening to your child, you’ll be able to identify their stressors and help them cope. Some common things that cause kids stress are:

• relationships with friends
• teasing and bullying at school
• family relationships – tension with parents and siblings
• being tired
• being hungry
• worrying about world events
• being stuck inside because of weather.

Helping kids stay calm

Check out these strategies you can use to help your child shift from feeling stressed, anxious or frightened to feeling safe and calm, and ready to move on.

• Watch closely. How does your child take in information? How do they seek out social connection and communicate?
• Respond. Acknowledge their feelings and respond with reassuring words or a hug. Talk about helpful ways of managing feelings and encourage your child to try out different options.
• Remember that it’s not always easy for kids to know what’s bothering them, and they may not always be able to talk about it.
• Show empathy. Try to see things from your child’s perspective and understand their motives. This helps you to ward off any potential problems and respond quickly and appropriately.
• Use problem-solving techniques. Talk about the things that are bothering them. Break the problems down together and help your child see the different perspectives and solutions. Find out more about problem-solving
• Provide structure and predictability. Have age-appropriate routines and limits.
• Include relaxation breaks in your day. Give stretching, exercise or quiet time a go.
• Teach by showing. Show kids how you manage your own feelings effectively. Acting calmly will help to reassure your child that they too can manage difficult feelings.

Useful questions to ask yourself:

• How do you know when your child is feeling overwhelmed or stressed?
• What do you do to help them become calmer? Does it work?
• What else could you try?

Developing communication skills

Good communication is always a two-way thing. Listening to children is as important as what you say to them and how you say it. This might not always be easy – especially when you’re tired, busy or have to deal with complaining or conflict – but it’s important to model good communication skills so your kids can learn from you.

Approaching communication as a conversation between family members helps kids develop skills for life, setting them up for strong, respectful relationships and feeling able to ask for support when they need it.

Communicating as a family

Talking together and discussing everyday things helps family members feel connected. It builds trust and makes it easier to ask for and offer support. Making time to listen and show interest encourages kids to talk and helps you understand how they think and feel. Listening actively helps to build relationships and communication skills.

To get your kids to talk more, take notice of the times when they do talk. Often this is while doing everyday things like household chores or while playing games together. Use these relaxed times to get a conversation going with them. Similarly, it’s important to make sure that the adults in the family have relaxed times to talk together.

Top tips for communicating with your kids:

• Make talking part of your routine. Make time to chat with your kids every day. If your child wants to share something, give them your full attention and listen without getting distracted.
• Let your child talk about whatever interests them. Show respect for their interests, even if listening to a run-down of the world they’ve built in Mine Craft or their expanding Pokemon collection isn’t the most exciting topic for you.
• Talk about your interests with your kids. Whether it’s sport, music or cooking, sharing the things that make you happy is important too.
• Show affection. We communicate through our actions as well as words. Hugging and showing affection makes kids feel loved and content.
• Reinforce that you’re there for them. Let your kids know that they can talk to you about anything. Setting this up early will help down the line as they get older and become more independent.

When things get tough

Talking about what’s bothering us can be hard – for both kids and adults. We need to feel safe and supported, and trust that we’ll be listened to and understood.

Asking how your child feels and listening non-defensively allows you to work together to solve problems. Blaming, judging or criticizing will quickly shut down real communication and very often leads to arguments.

Listening carefully to the other person’s perspective and explaining your own feelings and views (“I’m disappointed that…” or “I’m upset that …”) rather than accusing (“You don’t care…” or “You’ve upset me…”) helps to defuse arguments and supports effective communication.

Build supportive relationships

Quality relationships are important for resilience. You can help develop your child’s resilience by helping them build and strengthen their relationships with other children, and with significant adults in their lives – including your parent-child relationship.

It is important to remember to:

• spend quality time with your child
• support your child to build relationships with other adults
• help your child develop social skills and friendships with peers
• help your child to develop empathy.

Spend quality time with your child

Connect with your child. Connect with your child by doing things together that you both enjoy – for example, taking walks or watching your favorite movies together. Use this quality time to talk with your child and stay connected with the things that are important to them and any concerns they have.

Show warmth and affection

• Pre-school aged kids (1–5 year olds). Warmth and affection is important for your child’s development. Touch is particularly important in the first few years of life for creating a strong attachment between adult and child. Learn how your child likes to be shown affection – for example, a hug or a kiss – and show your child regular affection. It will help to establish a parent-child relationship of trust.
• Primary school aged kids (6–12 year olds). Use your quality time together to show affection and acceptance while respecting their individual comfort level (these may vary in public places such as at school). Talk with your child about who they are, what they value, what they like and don’t like – be accepting of differences that exist between you and your child.

Talk with your child

• Pre-school aged kids (1–5 year olds). Talk with your child about things that interest them. Ask them open questions such as, “Tell me about all the things you like about going to the park”. “Tell me about the things that you don’t like about going to park.” By asking open questions, you’ll get a unique insight into your child’s world and what they value.
• Primary school aged kids (6–12 year olds). Talk often with your child about things that are happening in their life – interests, sports, friends, teachers, school etc. Use open questions to talk with them about these things, such as “tell me all about school”. By asking open questions, you’ll get a unique insight into your child’s world and what they value. If you ask closed questions like, “Did you enjoy school today?”, you’ll most likely get short responses and have little understanding about your child’s day.

Do activities that extend your child’s development

• Pre-school aged kids (1–5 year olds). Do activities with your child that extend their development. For example, building blocks are good for developing children’s fine motor skills. As this is a developing skill, your child may find it difficult to master. Encourage your child in a positive and supportive way. You could say, “I can see this is difficult and it’s so good that you are trying!”
• Primary school aged kids (6–12 year olds). Listen carefully if your child expresses any worries and try to understand their point of view. Avoid making assumptions on your child’s behalf. Listen to your child’s description of the challenge they’re experiencing and find out what they value. For example, ask questions like, “Tell me about what’s difficult for you”.

Teach your child about emotions

• Pre-school aged kids (1–5 year olds). Young children are learning about their emotions. You can help your child to learn about how they feel, by labeling emotions in themselves. For example, if they experience frustration when building blocks.
• Primary school aged kids (6-12 year olds). When your child is having a hard time, ask them how you can best support them. This will give them a sense of control and choice in handling the situation.

Support your child to build relationships with other adults

• Help your child connect with family history. Help your child connect to the people and history in your family including aunts, uncles, grandparents and cousins, as well as other important adults who may not be related but are also important. Tell stories from the past about family members, look through old photographs and share memories. Encourage and organise for your child to spend time with family and friends. Older children could also keep in contact by phone, email, Messenger or Skype. You play a vital role in helping your child to develop good relationships with extended family members and friends.
• Involve your child in local community activities:
  • Pre-school aged kids (1–5 year olds). Encourage your child’s sense of belonging by involving them in the local community from an early age. There are many great, low cost things to do in local communities – such as groups at local libraries and community playgroups, which allow them (and you) to connect with others in the local community.
  • Primary school aged kids (6–12 year olds). Encourage your child to connect with different types of people in your community – by attending local community events and working bees at your child’s school. This will expose your child to different types of people, and give them a greater sense of purpose and belonging outside of your immediate family.

Help your child develop social skills and peer networks

Friendships are important to your child’s development. Help your child to practise and improve their social skills so that they can form friendships with their peers. Kids learn how to manage relationships by observing the ways that other people around them relate to each other. You are their role model.

Encourage your child to socialize

• Pre-school aged kids (1–5 year olds). There are many social skills that your child will develop early in life that will support them to form friendships as they grow up. These skills include learning to share, taking turns, following rules, compromising and self-control. You can role model these skills at home. Give your child a head start by taking turns when playing board games or compromising when family members have different preferences.
• Primary school aged kids (6–12 year olds). Your child’s opportunities to make friends expand once they go to school, as does their autonomy in making friends. Encourage your child to participate in activities that allow them to meet new people, for example, through extra-curricular activities such as sport, arts and music. Pay attention to the friends your child is making.

Encourage your child to play with friends

• Pre-school aged kids (1–5 year olds). Young children (under the age of four) tend to play alongside each other rather than ‘playing with’ other children, though this usually changes around the time they reach pre-school. Take your child to places where there will be other children to play with. For younger children, you should monitor their play so that you can intervene if things start to go wrong, such as if your child wants the same toy as another child. Take the time to reinforce sharing and taking turns when these situations arise.
• Primary school aged kids (6–12 year olds). Encourage your child to invite other children over to play. If your child is new to having friends over, or has had difficulty in the past, talk with them about: suitable activities for when their friend visits; how your child will know when it’s time to change games; and how your child will know if their friend is having a good time.

Help your child to support others

• Pre-school aged kids (1–5 year olds). Help your child to develop empathy towards other children as outlined in the next section.
• Primary school aged kids (6–12 year olds). Help your child to think about ways they can support their friends when they’re going through a challenging time. Come up with a list of ideas and put all the ideas together in a folder at home and refer to them regularly. Use the opportunity to talk with your child about how they would like to be supported in a similar situation.

Help your child to develop empathy

Empathy is important to building good relationships because it involves being sensitive and understanding the emotions of others and responding in appropriate ways.

• Role model positive relationships. Provide your child with opportunities to practice being empathetic. Your child will learn how to be empathetic by observing you and other adults in their lives. Try to role model positive relationships and interact with others in a kind and caring way.
• Read age appropriate books
  • Pre-school aged kids (1–5 year olds). Read books with your young child about feelings.
  • Primary school aged kids (6–12 year olds). Read age appropriate books with your child about a character who is having a difficult time. Ask your child to reflect on the emotional experience of the character and imagine how they would feel in the same circumstance. Ask your child how they would like others to respond to them if that happened.
• Empathize with your child
  • Pre-school aged kids (1–5 year olds). Empathize with your child. For example in a thunder storm you could say “the thunder is really loud. Are you scared of the thunder? You can stay close to me until the thunder passes.”
  • Primary school aged kids (6–12 year olds). Talk with your child about other children they know who may be having a tough time. Ask your child how they would feel in that situation, and what they can do to support the child.
• Talk with your child about others’ feelings
  • Pre-school aged kids (1–5 year olds). Talk with your child about others’ feelings. For example, “Raimy is feeling sad because you took his toy truck. Please give Raimy back his truck. You choose another one to play with.” You can also use pretend play to talk about feelings as you play with your child.
  • Primary school aged kids (6–12 year olds). Talk with your child about ways to show empathy such as: listening; opening-up and sharing with others; using physical affection (if appropriate); noticing the feelings, expressions and actions of others; not making judgements; and offering help to others.
• Encourage empathy and role model being curious
  • Pre-school aged kids (1–5 year olds). Show your child how they can show empathy. For example, “Let’s get Chitra some ice for her sore leg.”
  • Primary school aged kids (6–12 year olds). Role model being curious. Invite your child to be curious about others. Notice the feelings, expressions and actions of others.
• Validate your child’s difficult emotions
  • Pre-school aged kids (1–5 year olds). Validate your child’s difficult emotions. Sometimes when children are sad, angry or disappointed, we try to fix the problem straight away and protect our child from any pain. However, these feelings are part of everyday life and our children need to learn how to cope with them. Labelling and validating difficult emotions helps children learn to handle them. For example, “I can see you’re angry that I’ve taken away your iPad. I understand that and I know you like using your iPad. It’s OK if you’re angry. When you’re finished feeling upset, would you like to come outside and help me dig in the garden or shall we make some muffins in the kitchen?”
  • Primary school aged kids (6–12 year olds). Validate your child’s difficult emotions. Sometimes when children are sad, angry, or disappointed, we try to fix the problem straight away and protect our child from any pain. However, these feelings are part of everyday life and our children need to learn how to cope with them. For example, “I can see that you are sad because you were not invited to Joseph’s party. It’s normal to feel that way but it’s important to remember that you have many friends who enjoy spending time with you.”
• Interact with a diverse range of people
  • Primary school aged kids (6–12 year olds). Look for opportunities to volunteer with your child. This will help your child to understand the needs of others and allow them to interact with a diverse range of people.
• Practice experiential empathy
  • Primary school aged kids (6–12 year olds). Help your child to practice ‘experiential’ empathy by taking on the tasks of someone else (perhaps yourself) for a day.

Focus on autonomy and responsibility

Autonomy and responsibility play an important role in building children’s resilience. You can encourage your children to take on responsibilities and develop a sense of autonomy. It’s important to remember that as parents, it’s natural for us to want to protect our children from negative experiences, but it’s important not to shield them completely from life’s challenges. Working through difficulties and problems – with adult support as required – will give your child a chance to learn about themselves, develop resilience, and grow as a person.

• Build your child’s independence
  • Pre-school aged kids (1–5 year olds). Build your child’s autonomy and independence. For example, encourage your child to dress themselves or give money to a shopkeeper – gradually increase the complexity of the tasks as your child builds their independence.
  • Primary school aged kids (6–12 year olds). Build your child’s autonomy and independence. You could encourage your child to prepare their own school lunch or contribute to cooking the family meal – gradually increase the complexity of the tasks as your child builds their independence.
• Talk to your child about problem solving
  • Pre-school aged kids (1–5 year olds). Talk to your child about how they might address a problem, rather than rushing in to solve the problem for them. For example, ask your child what he/she might do if they wish to play with the toy that another child is playing with.
  • Primary school aged kids (6–12 year olds). Talk to your child about how they might address a problem, rather than rushing in to solve the problem for them. For example, ask your child what they might do if they forget their lunchbox, so the child doesn’t have to rely on their parents to deliver the lunchbox to school.
• Allow your child to make decisions
  • Pre-school aged kids (1–5 year olds). Give your child opportunities to make meaningful decisions. For example, give choices and allow your child to select their preference. For example, allow them to decide the order in which certain things will be done, or which book they want to read.
  • Primary school aged kids (6–12 year olds). Talk to your child about how he/she can develop strategies for dealing with difficult situations. For example, help your child to develop a plan for when they feel left out of a friendship group, of if they are feeling stressed about school tests. Remind your child of all the people around them who can help. Encouraging your child to come up with their own solutions helps them to learn problem solving.
• Provide opportunities for free play
  • Pre-school aged kids (1–5 year olds). Provide opportunities for free play – open ended and improvised play – such as building blocks, playing with teddies or action figures, or painting on blank paper are great examples of free play for young children.
  • Primary school aged kids (6–12 year olds). Provide your child with opportunities to make meaningful decisions. For example, let them decide how they want to arrange their bedroom, or what they want to do as an end of year celebration.
• Being bored is not necessarily bad
  • Primary school aged kids (6–12 year olds). Being bored occasionally is not necessarily bad for children. Your child may come up with their own ideas (such as devising a new game or building a cubby house). These occasions help children develop their sense of autonomy.
• Be a role model for your child. Be a role model for your child. Try to model ‘healthy thinking’ when facing challenges of your own. You can do this by thanking other people for their support, and saying, “Things will get better soon. I can cope with this”. This shows that you expect that good things are possible. You can also role model calm and rational problem-solving when something doesn’t go as expected. Talk out loud the thought process you are having in solving a problem. Your child can see what problem-solving looks like, and also that the problem can be worked through in a calm way to find a solution.
  • Healthy thinking means looking at life and the world in a balanced way (Canadian Mental Health Association, 2011). Healthy thinking teaches children to know how their thoughts (both helpful and unhelpful) affect problems or feelings in everyday life. With practice, children can learn to use accurate thoughts that encourage them instead of negative thoughts that discourage them.

Create opportunities for personal challenge

Provide your child with opportunities to build their confidence and learn how to deal with obstacles, success and failure when they undertake personal challenges.

It is important to remember the following:

• One idea that is very relevant to building children’s confidence by taking personal challenges is ‘healthy risks’. Healthy risks are age and developmentally appropriate risks such as walking to the shops with a sibling or alone. Healthy risks are not only about the risk of getting physically hurt, but also about the risk of losing, failing or making a mistake.
• As a parent, you need to define what you consider to be a ‘healthy risk’ for your child – depending on their age, maturity and your own comfort level. It may be useful to ask yourself what risks you have let your child take in the past. What was the outcome? Would you encourage your child to take that risk again? It may be helpful to discuss ‘healthy risk-taking’ with other parents.

Some examples of how you might do this:

• Teach your child to ‘have a go’. Teach your child to adopt a healthy attitude of ‘having a go’ early in life. Kids learn through trial and error and they need to learn how to tolerate failure when it occurs. Not learning to tolerate failure can leave children vulnerable to anxiety, and it can make them give up trying – including trying new things.
• Allow your child to experience everyday adversity
  • Pre-school aged kids (1–5 year olds). Give your child opportunities to experience ‘everyday’ adversity. This might involve going for a walk in the bush, even when there’s a chance of rain. Coping with the rain will help your child learn how to manage obstacles.
  • Primary school aged kids (6–12 year olds). Give your child opportunities to experience ‘everyday’ adversity. This might include being involved in sporting activities such as Little Athletics where there is the likelihood of losing. Learning how to deal with the disappointment of losing will help your child learn how to manage obstacles and other set-backs they experience in life.
• Encourage your child to do free play
  • Pre-school aged kids (1–5 year olds). Encourage your child to do free play activities (i.e. open ended and improvised activities). For example, give your child a box containing a range of different items, or a blank sheet of paper. Allow your child to determine what they will do with the items. Free play provides children with the opportunity to explore and helps build resilience.
  • Primary school aged kids (6–12 year olds). Encourage your child to do free play activities (i.e. open ended and improvised activities). For example, give your child a box of raw materials such as recycling items and allow your child to determine what they will do them. Free play provides children with the opportunity to explore and helps build resilience.
• Encourage your child to build independence
  • Pre-school aged kids (1–5 year olds). Encourage your child to build their independence by gradually increasing the difficulty of things they can do at home. For example, young children can help you to prepare the evening meal by setting the table or by assisting with food preparation such as washing the lettuce, or buttering the bread. Slowly increase the difficulty of the tasks as their skills develop.
  • Primary school aged kids (6–12 year olds). Encourage your child to take ‘healthy risks’. For example, this might involve walking to or home from school, alone or with a sibling. You may start by driving or walking your child halfway to school and allowing them to walk the remainder of the distance alone, or with a sibling.
• Talk to your child about self talk
  • Primary school aged kids (6–12 year olds). Talk with your child about self-talk and how you can shift the focus of self-talk in situations that aren’t going so well. Help your child practice reframing their self-talk. For example, a child might interpret being left out of a group as, ‘They don’t like me. I’m not worth liking. I’m not a nice person’. You can help them to shift their thinking by reminding them of times they’ve played happily with others, so they have good memories to call on.
• Help your child deal with difficult situations
  • Primary school aged kids (6–12 year olds). Help your child develop strategies to deal with difficult situations and encourage them to come up with their own solutions.
• Explore the benefits of community based organizations. Explore the benefits of community based organizations that provide opportunities for healthy risk-taking and developmental growth through activities such as orienteering, camping, leadership, physical activity, volunteering, and the arts (e.g. drama, theater groups, dance classes).

Encouraging independence

As children get older they can manage more and more tasks and decisions on their own. Some kids are confident trying new things, while others need a bit more encouragement.

Finding the right level of support can also be tricky – you’re trying to hit a sweet spot where kids are challenged and can learn through trial and error, but also feel secure and know that they have adult backing. It can be an adjustment for parents too, but one that pays off as kids’ self-confidence, maturity and resilience grows.​

Increasing autonomy through new experiences

Taking risks and being impulsive can be part of a younger child’s quest for new experiences, and kids are notorious for testing boundaries. You can help by providing structure and gradually introducing different challenges, giving them space to experiment and figure things out by themselves within the safety of your family.

Taking them to a different playground with bigger play equipment, getting them to help when you’re preparing meals and encouraging them to play on their own for short time periods are all ways you can support this growing independence.

It’s important to remember that the part of our brain that processes consequences develops much later than the parts responsible for actions – in short, kids often do things without thinking through what will happen as a result. Make sure you balance their growing need for independence with enough supervision to ensure they’re always safe from harm – to themselves and other kids.

Establish clear limits

It’s important to be clear about what behavior is OK and not OK in your family. Sit down together and talk about the rules of the house, and set the consequences for breaking those rules. It can help to display the rules somewhere visible – on a poster, behavior chart or the fridge.

For younger children, keeping it simple works well – for example no hitting, no breaking things, inside voice/outside voice etc. Consequences can also be pretty straightforward, such as time out, or removal of a toy for a time period.

As kids get older you can keep updating the family rules together. Remember that rules don’t always have to be negative. Think of them as guidelines for how everyone in the family treats each other, and expects to be treated in return.

Pay attention to their needs

Paying attention to your child’s emotional needs helps them feel secure and gives them the confidence to be more independent.

Here are some ideas:

• Pick some fun activities that they enjoy and that give you a chance to spend some one-on-one time together. Things like baking, going for a day trip, or making a book of family photos are all good options.
• Develop a habit of doing something special with each child once a month away from the rest of the family.
• Try and eat dinner together as often as you can. This can be challenging, as younger kids often need to eat earlier and might not want the same food as the rest of the family. Dishes like tacos or mini pizzas can work well as a family meal as everyone gets to choose their own ingredients.
• Encourage friendships, especially ones they’ve made themselves.

Know when to back off

It’s important to balance adequate supervision with giving kids the space to figure things out on their own. Give them a chance to make mistakes and try to avoid taking over. If you’re unsure if you’re stepping into a situation too often or too early, ask yourself “Do I really need to get involved?” and, “What would be the worst thing that can happen if I don’t step in?”

Dealing with bullying

Bullying is all about power – making yourself feel bigger and stronger by putting someone else down.

It involves deliberately and repeatedly attempting to hurt, scare or exclude someone. And it can be overt – hitting, pushing, name-calling – or more indirect, such as deliberately leaving someone out of games, spreading rumors about them, or sending them nasty messages.

Whatever form it takes, bullying can be incredibly damaging. It causes distress and can lead to loneliness, anxiety and depression. Bullying can also affect children’s concentration and achievement at school.

When children have been bullied they may:

• not want to go to school
• be unusually quiet or secretive
• be more unhappy or anxious than usual, especially before or after school, sport or wherever the bullying is happening
• not have many friends
• become more isolated – stop hanging around with friends or lose interest in school or social activities
• seem over-sensitive or weepy
• have angry outbursts
• have trouble sleeping
• complain about having headaches, stomach aches or other physical problems.

You may notice that their belongings have been damaged or are missing.

There might be other reasons for some of these signs in your child, so it’s best to talk together about what’s going on and any changes you’ve noticed.

Raising the issue

If you suspect your child is being bullied, it can be hard to know how to raise it with them. Some kids try and hide what’s happening, or feel ashamed, afraid or might not want you to worry or make a big deal. Often children just want the bullying to stop without confronting the issue or drawing attention to it.

They might find it uncomfortable discussing their feelings and emotions openly with you, or get angry and defensive when you ask if they’re OK. Try to stay calm, and realize you may need to raise the conversation in different ways over time to get a response.

What you can do to help

• Listen and provide support.
• Try to understand what has been happening, how often and how long it has been happening
• Encourage social skills and clear communication – being assertive, telling the bully to stop and seeking help
• Come up with some practical steps and strategies together – who they can talk to at school and what they can do when the bullying is happening.
• Talk with your child’s teacher and ask for help.
• Keep talking with the school until your child feels safe.

If your child tells you about bullying they’ve seen or heard at school:

• encourage them to stand up for the child who is being bullied
• encourage your child to report what they’ve seen or heard to school staff

If your child is doing the bullying:

• make sure your child knows bullying behavior is unacceptable and why
• try to understand the reasons why your child has behaved in this way and look for ways to address problems
• encourage them to think about the other person’s perspective, such as “how would you feel if …”
• help your child think of alternative ways of dealing with situations and communicating their feelings.

To help prevent cyber-bullying you can:

• supervise children’s use of electronic devices
• talk to kids about staying safe online. It can help to remind them that the internet is still ‘real life’ and you should behave the same – and expect the same behavior from others – as you would in person.

Teenage relationships

The early teenage years see lots of changes – physical, emotional, cognitive and social. During this time, teenage bodies, emotions and identities change in different ways at different times.

Romantic relationships are a major developmental milestone. Teens and dating come with all the other changes going on during adolescence – physical, social and emotional. And they’re linked to your child’s growing interest in body image and looks, independence and privacy.

Romantic relationships can bring lots of emotional ups and downs for your child and sometimes for the whole family. The idea that your child might have these kinds of feelings can sometimes be a bit confronting for you. But these feelings are leading your child towards a deeper capacity to care, share and develop intimate relationships.

When you are young, dating should be a fun activity. There is ample time in the future for more serious relationships. Many teens feel they need to have a boy or girlfriend, but what is really most important is learning to build healthy relationships. Utilize this youthful time to explore a variety of healthy attachments, including family, friends, and dating. Your experiences now set the stage for developing love and secure relationships as you grow and mature.

Early teenage relationships often involve exploring physical intimacy and sexual feelings. You might not feel ready for this, but you have an important role in guiding and supporting your child through this important developmental stage.

The most influential role models for teenagers are the grown-ups in their lives. You can be a positive role model for respectful relationships and friendships by treating your partner, friends and family with care and respect. Just talking about both men and women respectfully lets your child know you think everyone is equal and valuable.

Younger teenagers usually hang out together in groups. They might meet up with someone special among friends, and then gradually spend more time with that person alone.

If your child wants to go out alone with someone special, talking about it with him can help you get a sense of whether he’s ready. Does he want a boyfriend or girlfriend just because his friends do? Does he think it’s the only way to go out and have fun? Or does he want to spend time getting to know someone better?

If the person your child is interested in is older or younger, it could be worth mentioning that people of different ages might want different things from relationships.

Talking about teenage relationships with your child

Your family plays a big part in the way your child thinks about teenage relationships.

When you encourage conversations about feelings, friendships and family relationships, it can help your child feel confident to talk about teenage relationships in general. If your child knows what respectful relationships look like in general, she can relate this directly to romantic relationships.

These conversations might mean that your child will feel more comfortable sharing his feelings with you as he starts to get romantically interested in others. And the conversations can also bring up other important topics, like treating other people kindly, breaking up kindly and respecting other people’s boundaries.

Having conversations with your child about sex and relationships from a young age might mean your child feels more comfortable to ask you questions as she moves into adolescence.

In some ways, talking about romantic and/or sexual teenage relationships is like talking about friendships or going to a party. Depending on your values and family rules, you and your child might need to discuss behavior and ground rules, and consequences for breaking the rules. For example, you might talk about how much time your child spends with his girlfriend or boyfriend versus how much time he spends studying, or whether it’s OK for his girlfriend or boyfriend to stay over.

You might also want to agree on some strategies for what your child should do if she feels unsafe or threatened.

Young people might also talk to their friends, which is healthy and normal. They still need your back-up, though, so keeping the lines of communication open is important.
Some conversations about relationships can be difficult, especially if you feel your child isn’t ready for a relationship. Check out our article about difficult conversations for more tips on how to handle them.

Talking with your child about sexuality

It’s a good idea to make your ground rules clear to your child from very early on – that way, she’ll understand your values and expectations about behavior. For example, a rule might be that your child treats others with respect and always checks on consent before sexual activity. But on other, less important issues, you might choose to negotiate with your child and set the boundaries together, so she feels involved and listened to.

Here are some ideas and strategies to make it easier to talk with your child about sexuality.

• Start conversations early. There’s no perfect time to start talking about sexuality, but conversations from a young age can help your child understand that sex and sexuality are a normal, healthy part of life. Early conversations can help make later ones easier.
• Be prepared. Your child might ask you all sorts of questions, so it’s good to check your understanding of puberty, periods, contraception, wet dreams, masturbation and more. It might also help to think in advance about your values and beliefs so you can be clear and consistent with your child. For example, if your child feels confused about her feelings for someone and asks you about same-sex attraction, responding positively and non-judgmentally is a good first step. So sorting out your own feelings about this issue in advance is a good idea.
• Talk about the really important stuff. There are some things it’s really important for every young person to understand:
  • Your child has the right to say ‘no’. All young people have the right to control what happens to their bodies, and your child should never feel pressured into doing anything that doesn’t feel right. Talk with your child about recognizing what feels comfortable and safe, rather than doing what his friends are doing.
  • ‘Safe sex’ means protecting against pregnancy and sexually transmitted infections. Your child can do this by using condoms if she’s sexually active.
  • If your child is sexually active, it’s important to be tested for chlamydia – this condition is usually symptomless and is very common in young people of both sexes.
  • Your child can get advice about sexuality and sexual health from several places, including his GP. You can also tell your child that he can ask you anything he wants.
• Think about what you don’t know. When you work out what you don’t know, you can also work out how to get the information you need. There are many reliable sources, including:
  • a doctor or sexual health professional
  • your child’s school counselor
  • community health services and organizations, like the Family Planning organization or a sexual health clinic (generally free and confidential) in your state
  • books and pamphlets
  • the parenting hotline in your state or territory.
• Choose your words carefully. It’s important to pitch your language and terminology at a level that’s right for your child.
• Read your child’s signals. Look out for signs that show that now isn’t the right time for a ‘big talk’, like when your child is busy, tired or distracted. You can always try again later.
• Remind yourself about why discussing sexuality is important. When you keep the communication channels open, you help your child make positive, safe and informed choices, now and in the future. But if you delay talking about sexual health, you might miss an opportunity to help your child make positive decisions.

Talking about sexuality is particularly important if you want your views to help guide your child’s own sexual decision-making process.

Teenage sexuality

Sexuality is a part of who your child is and who she’ll become. Sexuality develops and changes throughout your child’s life. Feeling comfortable with her sexuality and sexual identity is essential to your child’s healthy development.

Sexuality isn’t just about sex. It’s also about how your child:

• feels about his developing body
• makes healthy decisions and choices about his own body
• understands and expresses feelings of intimacy, attraction and affection for others
• develops and maintains respectful relationships.

Your child’s beliefs and expectations about sex and sexuality are influenced by her personal experiences, upbringing and cultural background.

And you’re your child’s most important role model. You can help your child by modelling and reinforcing values and beliefs about safety, responsibility, honest communication and respect in relationships by treating your partner with respect and talking about how to stay safe.

Teenage sexual behavior, sexual attraction and sexual identity

Most teenagers will experiment with sexual behavior at some stage – this is a normal, natural and powerful urge in these years. But not all teenage relationships include sex.

Teenagers are also maturing emotionally and socially. They might want romantic intimacy and ways to express love and affection. And they might be curious and want to explore adult behavior.

Some teenagers are sexually attracted to people of the opposite gender, some are attracted to people of the same sex, and some are bisexual.

Sexual attraction and sexual identity aren’t the same. Young people who are same-sex attracted might or might not identify as gay, lesbian or bisexual. They might identify as heterosexual.

Promoting open communication about teenage sexuality

Your child will learn about sexuality at school, talk about it with friends, and get information about it online and through social media. But young people do trust the information they get from their parents.

If you talk about sex and sexuality with your child, it will help him sort through the many messages he gets about sexuality. These conversations might not feel comfortable at first, but you can make them easier by:

• using everyday opportunities to talk about sexuality – for example, when you hear something on the radio together, or see something relevant on TV
• letting your child know that you’re interested in seeing things from his perspective – for example, asking him what he thinks about sexual identity
• being ready to talk about issues or concerns when your child raises them, and assuring your child that he doesn’t need to feel embarrassed
• being honest if you don’t know the answer to a question – you could suggest that you look for the answer together
• asking your child what he already knows, then adding new information and clearing up any misconceptions
• using active listening skills.

Sex and teenage relationships

If your child is in a relationship, it can bring up questions about sex and intimacy. Not all teenage relationships include sex, but most teenagers will experiment with sexual behavior at some stage. This is why your child needs clear information on contraception, safe sex and sexually transmitted infections (STIs).

This could also be your chance to talk together about dealing with unwanted sexual and peer pressure. If you keep the lines of communication open and let your child know that you’re there to listen, he’ll be more likely to come to you with questions and concerns.

Talking with your child about sex, sexuality and relationships won’t encourage her to start having sex before she’s ready. In fact, the opposite is true. Comfortable, open discussions about sex can actually delay the start of sexual activity and lead to your child having safer sexual activity when she does start.

Same-sex attraction and early sexual experimentation

Sexuality develops and often changes over time. What happens in adolescence isn’t set in stone for the rest of your child’s life. She doesn’t have to label herself as ‘gay’, ‘straight’, ‘lesbian’ or anything else. Exploration and experimentation with sexuality is normal and common. The most important thing is to be safe.

For some young people, sexual development during adolescence will include same-sex attraction and experiences.

For 3-10% of young people, the start of puberty will mean realizing they’re attracted to people of the same sex. A larger number of young people might develop bisexual attraction.

If your child feels confused about his feelings or attraction to someone else, responding positively and non-judgmentally is a good first step. A big part of this is being clear about your own feelings about same-sex attraction. If you think you might have trouble being calm and positive, there might be another adult who both you and your child trust and who your child could talk with about his feelings.

Difficult conversations with teenagers

Difficult conversations cover any topic that might be embarrassing, upsetting or controversial for either you or your child. It could also be something that might cause an argument or a conflict between the two of you. Sex, sexual orientation, masturbation, alcohol or other drugs, academic difficulties, self-harm, secrets, work and money are all topics that families can find difficult to talk about. It’s normal to feel uncomfortable discussing these things with your teenage child. But difficult conversations can give you the chance to guide your child towards sensible and responsible decisions and to talk about your family values.

There are no scripts for difficult conversations and tricky topics. But it’s a good idea to think about these topics before your child asks. If you work out a few key points about sex, alcohol, parties and so on beforehand – and even practice them – you might not be caught so off guard when your child asks a tricky question about sex while you’re driving.

And when you’ve had a chance to think about these topics, it’s also a good idea to raise them before your child asks. For example, early conversations about things like sexting can help keep your child safe.

Here are some tips to help you manage difficult conversations

• First reactions
  • Try to stay calm. Be honest if you’re shocked by the topic, but reassure your child that you do want to discuss the issue. This can help your child feel he can talk to you about anything.
  • Make sure the first thing you say to your child is something that lets her know you’re happy that she wants to talk to you. For example, ‘I’m so happy that you trust me to help you with this’.
  • Listen to your child. This means giving your child a chance to talk through what’s going on, without you trying to fix the situation. Often, teenagers aren’t expecting you to fix things – they just want you to listen.
  • Avoid being critical or judgmental, or getting emotional. If you need to let off steam, choose another adult to talk to when your child isn’t around.
  • Thank your child for coming to you.

Next steps

• If you need a bit of time to calm down or gather your thoughts before you talk, set a time to talk later. Make sure it’s soon – don’t wait until the next day. The longer you wait, the harder it will be. Your child might go ahead without your input in the meantime.
• If your child has some specific issues he wants your help with and you’re not sure how to advise him, say so. Offer to work with your child to find out what he needs to know – for example, about contraception, sexuality, alcohol and so on.
• If your child wants your help with a tricky situation, a problem-solving approach can help you work together to find a solution.
• If your child wants your opinion, let your child know how you see the situation rather than telling her what to do. For example, ‘I would prefer it if you don’t have sex until you’re older. But if you’re going to, let’s talk about making sure it’s safe’.

Benefits of difficult conversations

Tackling difficult conversations together with your child is a sign that you have a healthy relationship.

It helps to keep your relationship with your child close and trusting. If you’re warm, accepting, non-judgmental and uncritical, and also open to negotiating and setting limits, your child is likely to feel more connected to you. Your child is also more likely to discuss issues with you in the future.

And if you know what’s going on in your child’s life, you’re better placed to help him manage difficult situations. Discussing tricky topics with you gives your child the opportunity to explore his choices and work out whether they’re the right ones for him.

Try not to avoid difficult conversations with your child. If you do, your child might end up making choices that have negative consequences. For example, a sexually active teenager who doesn’t ask for advice about contraception might end up with an unwanted pregnancy or a sexually transmitted infection.

When your child won’t talk

It’s common for teenagers to avoid talking about embarrassing or upsetting topics, especially if you raise them first. Sometimes you might not even realize a topic is upsetting or embarrassing until you raise it.

If your child doesn’t want to have difficult conversations with you, you could try the following:

• Try to set aside some time each day to talk with your child. Ask him open-ended questions, and let him know that if he does want to talk, you’re happy to listen. This will help you stay connected with your child and might help him feel more comfortable to come to you in future.
• Keep up to date with your child’s interests. This gives you things to talk about and shows that you’re interested in your child’s wellbeing.
• If your child won’t talk to you, it might help to find another adult she can talk to. You could suggest a relative, teacher, counselor or neighbor. But tell your child that you’re happy to listen any time she wants to talk to you.

Dating as a teenager

There isn’t a ‘right age’ to start having romantic relationships – every child is different, and every family will feel differently about this issue. But here are some averages:

• From 9-11 years, your child might start to show more independence from your family and more interest in friends.
• From 10-14 years, your child might want to spend more time in mixed gender groups, which might eventually end up in a romantic relationship.
• From 15-19 years, romantic relationships can become central to social life. Friendships might become deeper and more stable.

Many teenagers spend a lot of time thinking and talking about being in a relationship. In these years, teenage relationships might last only a few weeks or months. It’s also normal for children to have no interest in romantic relationships until their late teens. Some choose to focus on schoolwork, sport or other interests.

First crushes

Before your child starts having relationships, he might have one or more crushes.

• An identity crush is when your child finds someone she admires and wants to be like.
• A romantic crush is the beginning of romantic feelings. It’s about your child imagining another person as perfect or ideal. This can tell you a lot about the things that your child finds attractive in people. Romantic crushes tend not to last very long because ideas of perfection often break down when your child gets to know the other person better. But your child’s intense feelings are real, so it’s best to take crushes seriously and not make fun of them.

Teen breakups

Break-ups and broken hearts are part of teenage relationships. To make things worse, teenage break-ups might be played out in public – maybe at school, or online on social media.

You might expect your child to be sad and emotional if his relationship ends. It might not seem this way at the time, but this is part of learning how to cope with difficult decisions and disappointments. Your child might need time and space, a shoulder to cry on, and a willing ear to listen. He might also need some distraction.

Active listening can help you pick up on your child’s needs. But if your child seems sad or even depressed for more than a few weeks after a break-up, it might be worth getting some advice from a health professional, like your doctor.

Healthy relationships for teens

It’s important for teenagers in romantic, intimate and sexual relationships to understand what respectful relationships look like. As a parent and role model you have an important role in talking with your child about respect and encouraging your child to be respectful in relationships.

Respectful relationships allow teenagers to feel valued and accepted for who they are. These relationships are a vital part of healthy social, sexual and emotional development for teenagers.

What do respectful relationships for teenagers look like?

Respect is about treating yourself and others with dignity and consideration. Respect is an essential part of romantic, intimate and sexual relationships for teenagers.

Teenagers in respectful romantic relationships:

• can make their own choices and don’t feel pressured to do things that make them feel uncomfortable – for example, they can choose what activities they want to do, and who they want to do these activities with.
• treat each other equally and fairly – for example, if they belong to different religions, it’s OK for them to follow their own beliefs
• see mistakes as normal and OK – for example, if they forget to phone each other, they say, ‘It’s easy to forget – next time it might be me who forgets’
• are only intimate and touch each other when they both want to – for example, they agree that they’ll have sex only when they’re both ready
• know it’s OK to say ‘no’ – for example, they can say, ‘No, I don’t want to drink any alcohol’
• communicate openly and sort out conflicts fairly – for example, if they disagree about how much time to spend with each other, they look at their commitments together and come up with a solution that works for both of them.

You can help your child to choose and build respectful relationships by talking with him about how people behave in respectful romantic and intimate relationships.

You could try asking open questions to get the conversation started. For example:

• What do you think is important in a relationship?
• How do you want to be treated?
• What kind of behavior shows you that someone truly loves or cares for you?

If your child has questions, try to answer them honestly and openly. If you can have conversations like this with your child, it encourages clear, open and honest communication. It also makes it easier for your child to come to you in the future if she needs help with a relationship.

Other ways to encourage respectful relationships

Here are some other ways that you can promote caring and respectful relationships:

• Be a role model for respectful and caring behavior in your own relationships. And if you find yourself in a disrespectful relationship, model positive ways to manage that – for example, by being assertive, talking with the person involved or seeking professional help.
• Use active listening to understand your child’s and other people’s perspectives.
• Give your child praise for respectful behavior – for example, ‘It’s great how you stayed calm and walked away when you were feeling really angry. You took responsibility and didn’t take your anger out on someone else. Well done!’
• Manage your own anger and teach your child how to manage his anger. For example, if you need to calm down when you’re feeling angry, tell yourself to stop, breathe and relax.
• Show your child how to put conflict management strategies into action. For example, you could say something like ‘I feel really upset and worried when you don’t come home at the time we agreed on. Can we talk about that?’ This shows your child how to use ‘I’ statements and be specific.
• Stand up for yourself and your own needs in a respectful way and teach your child to stand up for herself. You could do this by saying no to others – for example, ‘I can’t help out tomorrow. I’ve got a report to finish’.

What are disrespectful relationships?

A disrespectful relationship is one in which people don’t feel valued. It might be a relationship where one person is treated unfairly or even experiences abuse.

Your child might not realize a relationship is disrespectful to start with, or he might misinterpret signs. For example, he might see jealousy or constant text messaging as a sign of love, rather than as a warning sign of abuse.

Disrespectful behavior can also start off small and can grow over time and turn into abuse. For example, something can start as minor jealousy about spending time with others. Teenagers might even misinterpret this as romantic. But this kind of jealousy can result in people becoming isolated from friends and family as relationships progress.

In a disrespectful relationship one person might:

• try to control the other person – for example, by stopping the other person from seeing family and friends, or controlling where the person goes and who the person sees
• blame and humiliate the other person – for example, by saying things like ‘If you hadn’t said that, I wouldn’t have got angry’ or ‘This is all your fault! I can’t believe I put up with you!’
• use emotional blackmail – for example, by saying things like ‘If you don’t come straight to my house after school, I’m going to tell everyone what a loser you are’ or ‘If you leave me, I’m going to kill myself’
• verbally abuse the other person – for example, by shouting or using put-downs like ‘No-one will ever like you’ or ‘You’re useless’
• physically abuse the other person – for example, by shaking the person during an argument, or holding the person’s wrist to prevent the person moving away
• sexually abuse or sexually assault the other person – this is any unwanted and forced sexual contact, including forced kissing, touching and vaginal, oral or anal penetration
• follow or harass the other person or use cyberbullying – for example, by repeatedly texting demanding to know where the person is, or spying when the other person is out with friends.

Effects of disrespectful relationships

Being in a disrespectful relationship can affect your child’s health and wellbeing.

Common effects include:

• changes in sleep and eating habits – for example, your child might have nightmares, trouble sleeping or a sudden loss of or increase in appetite
• feelings of depression or anxiety
• low self-confidence or self-worth – for example, your child might say things like ‘I’m completely useless’ or she might give in to her partner to prevent conflict
• isolation from family and friends – for example, your child might not want to join in with social activities, or might spend a lot of time alone in his room
• problems with alcohol or other drugs.

What to do if your child is in a disrespectful relationship

If your child is in a disrespectful relationship or you think she is, she needs your support. You can start by talking with your child, but this might be a difficult conversation.

You can encourage your child to express his feelings about the relationship by asking questions like these:

• How do you feel about yourself when you’re with your boyfriend/girlfriend?
• How do you feel about that behavior?
• What do your friends say about your boyfriend/girlfriend and the way he/she treats you?
• Is there anything about the relationship that makes you feel uncomfortable?

You can also talk with your child about her options and what might happen. For example:

• What are the pros and cons of staying together?
• What might happen if you stay together?
• What might happen if you break up?

You can also ask your child how you can help. Your child might not want to talk with you about his relationship. In this situation, it might help if another trusted adult can talk to your child – for example, an aunt or uncle, grandparent or family friend.

Getting help for your child

You can help your child get professional support from a psychologist, psychiatrist, counselor or doctor. Your child can also talk with a school counselor. These professionals can help you and your child find other relevant services in your area.

Teen dating advice

The world of teen dating is filled with many successes and failures. As children grow and mature into their adult bodies, their interests may turn to dating – this can be a rough transition for teens and parents alike.

Before dating begins and Before asking anyone out on that first date, create a list of the qualifications that you require in a respectable girl or boyfriend. Be specific and list both the things that are the should have’s and the ones that are the should have not’s. While analyzing a possible date, also think about what you have to offer to a potential new friend.

Teen dating tips

• Communication is essential in all dating. Don’t make assumptions and avoid gossip.
• Make it clear whether your relationships are exclusive or casual.
• If you get turned down or rejected, don’t waste time on it – move on.
• Before asking anyone new out, get to know them a little first. It will make it easier to know what their answer might be.
• If you are looking for love, don’t mistake sex as the same thing. It isn’t. While making love may make you feel loving, it won’t necessarily make you feel loved. If it is just sex, it is like eating ice cream when you are hungry. It tastes good at the time, but it doesn’t nourish you. Then it often makes you feel worse shortly thereafter, because what your body was really craving was something healthy.

Friends

Creating strong friendships is the first step toward a healthy teen dating life. As a teen, your friends will largely affect your self-esteem and enjoyment. Make sure there is always a balance between your time with your friends and your time with your date when you begin to explore dating. Don’t waste all your energy on a new boy or girlfriend, only to have the relationship explode and you quickly notice you no longer have anyone to call and complain too.

Love vs. Lust

There are many types of love: compassion for others, strong friendships or family connections. Teen love involves finding someone who you are attracted to who understands and appreciates you. Lust is a quick, intense physical attraction. Teen lust is sexual and driven by hormones. While it a normal physiological part of growing up, it can be very powerful and confusing.

It can be hard to tell the difference between love and lust as a teen. This complicates the teen dating scene significantly. Keeping a healthy perspective and appreciating that these emotions are significant and real will help facilitate the process. As a teen, allow yourself to feel these varying emotions but find healthy outlets for them. Savor your ability to learn control as it will benefit you in all aspects of your life as you leave your teen years.

Know that your first love, and even your second love, and maybe even your third love and beyond are very unlikely to be your last(ing) love. So often teens start dreaming about happily-ever-after with the first person they date, which is understandable, but not realistic. While it does happen, it is not likely. Remember as you are dating that this is a love, not the love and there will always be more love. Love is abundant, not scarce. Any scarcity we experience is not based on the truth about love, it is based on our inability to access it.

Trust your intuition

Along with friends for comfort and support, also comes the peer pressure naturally found in all teens’ lives. As you begin to explore a variety of relationships in your teens, try to listen to your inner voice, instead of the loud voices of your circle of friends. It can be hard to tone down the pressure teens feel in today’s world, so before you make any decisions about who to date or how to behave, quiet down those outside voices. Take a silent walk alone or write in a journal. Your inner voice will know the right choices for you; just take the time to listen.

Know yourself

With all the conflicting messages in teens’ lives, it can be hard to know what they want when it comes to dating and relationships. As a young teen, take some time to get to know yourself before you start dating. Join a variety of activities and explore your own interests. Not only will this make you more interesting as a date, but it will also help you appreciate the types of people you want intimately involved in your life.

Don’t rush

Instead of feeling pressure to move quickly into an intimate relationship, recognize that rates of sexual activity among teens have been steadily decreasing in the last 20 years. That means that any justification that “everyone else is doing it” simply isn’t true.

Teen breakups

Relationship break ups are a part of life. It can be hard to watch your teenager go through the distress and pain of breaking up for the first time. Not every relationship lasts forever, in fact most don’t. It is normal for teenagers to have a number of short-lived relationships as they go through puberty and discover more about their emotions, their needs, and other people’s human imperfections. Teenagers have as much to learn from break ups as they do from having relationships.

Your teenager is likely to be confused and upset. They probably didn’t see this coming, and don’t understand what happened or why. This part of their life that they loved has ended and they will be grieving for that time.

You can help them through this distressing time by supporting them, giving them guidance on what comes next, and showing them how to handle a break up respectfully. You can’t take away their pain, but you can help them develop resilience and understanding.

Tips for helping your teenager through a break up

• You don’t have to find the right thing to say. There might not even be one. Just be there to listen when they need it.
• Let them vent. When we talk about what we are feeling, we move things from the emotional to the logical part of our brain, helping us to process. Just letting them talk helps.
• Encourage them to talk with friends. Getting support and validation from friends strengthens those relationships, and shows your teenager they are not alone.
• Help them establish a routine. When a break up happens it feels like the rug has been pulled out from under us, and we feel like we have less control. Just having a regular routine helps regain that sense of control.
• Encourage them to treat themselves. Doing things they like, going to the movies etc. will help them remember that they don’t need someone else to be happy and have a good time.

Ideas worth talking about

You may not be able to say the right thing to make it all better, but you can help them to understand the nature of relationships and break ups.

• It takes time to heal. It may not feel like the grief or feelings they are going through will go away, but they will in time. There will be good days and bad, and you will be there for them.
• Being single doesn’t mean being alone. It doesn’t mean being unloved. You have more opportunities to do different things, and meet different people. Friendships are just as valuable as romantic relationships.
• You can and will feel love like this again. Discuss how you might have had more than one relationship in the past, and how you found that you could feel love again.
• Break ups don’t have to be angry. You loved this person. While it may feel painful, or like you have been betrayed, we each have the right to choose whether we want to be in a relationship. In time, you may be able to still have this person in your life if you treat them well now.

When to get help

Getting over a break up takes time, and that time is different for everybody. If it has been several weeks and they are still not getting over these feelings, or they have persistent low mood and disengagement with their life and friends, it may be time to get additional help. Talk to your family doctor, or encourage your child to have a session with a counselor.

Adolescence development

Adolescence is the period of transition between childhood and adulthood. Adolescence is a time of big social changes, emotional changes, physical changes (puberty) and changes in relationships. These changes show that your child is forming an independent identity and learning to be an adult. However, the many physical, sexual, cognitive, social, and emotional changes that happen during this time can bring anticipation and anxiety for both children and their families. Understanding what to expect at different stages can promote healthy development throughout adolescence and into early adulthood.

Children and their parents often struggle with changing dynamics of family relationships during adolescence. Many people think that adolescence is always a difficult time, and that all teenagers have bad moods and behave in challenging ways. In fact, some studies show that only 5-15% of teenagers go through extreme emotional turmoil, become rebellious or have major conflicts with their parents. But parents are still a critical support throughout this time.

Social and emotional changes are part of your child’s journey to adulthood. You have a big role to play in helping your child develop grown-up emotions and social skills. Strong relationships with family and friends are vital for your child’s healthy social and emotional development.

Here are some ideas to help you support your child’s social, physical and emotional development:

• Help your child anticipate changes in his or her body. Learn about puberty and explain what’s ahead. Reassure them that physical changes and emerging sexuality is part of normal, healthy development. Leave room for questions and allow children to ask them at their own pace. Talk to your pediatrician when needed.
• Start early conversations about other important topics. Maintain open communication about healthy relationships, sex, sexuality, consent, and safety (such as how to prevent sexually transmitted infection and pregnancy, and substance use). Starting these conversations during early adolescence will help build a good framework for discussions later.
• Talk about relationships, sex and sexuality. If you talk about relationships, sex and sexuality in an open and non-judgmental way with your child, it can promote trust between you. But it’s best to look for everyday times when you can easily bring up these issues rather than having a big talk. When these moments come up, it’s often good to find out what your child already knows. Correct any misinformation and give the facts. Use the conversation as a chance to talk about appropriate sexual behaviour. And let your child know you’re always available to talk about questions or concerns.
• Be a role model. You can be a role model for positive relationships with your friends, children, partner and colleagues. Your child will learn from seeing relationships that have respect, empathy and positive ways of resolving conflict. You can also role-model positive ways of dealing with difficult emotions and moods. For example, there’ll be times when you’re feeling cranky, tired and unsociable. Instead of withdrawing from your child, you could say, ‘I’m tired and cross. I feel I can’t talk now without getting upset. Can we have this conversation after dinner?’
• Get to know your child’s friends. Getting to know your child’s friends and making them welcome in your home will help you keep up with your child’s social relationships. It also shows that you recognize how important your child’s friends are to your child’s sense of self. If you’re concerned about your child’s friends, you might be able to guide your child towards other social groups. But banning a friendship or criticizing your child’s friends could have the opposite effect. That is, your child might want to spend even more time with the group of friends you’ve banned.
• Listen to your child’s feelings. Active listening can be a powerful way of strengthening your relationship with your child in these years. To listen actively, you need to stop what you’re doing when your child wants to talk. If you’re in the middle of something, make a time when you can listen. Respect your child’s feelings and try to understand his perspective, even if it’s not the same as yours. For example, ‘It sounds like you’re feeling left out because you’re not going to the party on Thursday night’.
• Be open about your feelings. Telling your child how you feel when she behaves in particular ways helps your child learn to read and respond to emotions. It also models positive and constructive ways of relating to other people. It can be as simple as saying something like ‘I felt really happy when you invited me to your school performance’.
• Focus on the positive. Keep conversations with your child positive. Point out strengths. Celebrate successes. There might be times when you seem to have a lot of conflict with your child or your child seems very moody. In these times, it helps to focus on and reinforce the positive aspects of your child’s social and emotional development. For example, you could praise your child for being a good friend, or for having a wide variety of interests, or for trying hard at school.
• Honor independence and individuality. This is all part of moving into early adulthood. Always remind your child you are there to help when needed.
• Looking after yourself. It’s easy to get caught up in your child’s needs and the daily tasks of getting children to sporting and social activities. Even with all this going on, looking after yourself and making time for the things you enjoy can keep you feeling positive about parenting your teenage child.

Be supportive and set clear limits with high (but reasonable) expectations. Communicate clear, reasonable expectations for curfews, school engagement, media use, and behavior, for example. At the same time, gradually expanding opportunities for more independence over time as your child takes on responsibility. Youth with parents that aim for this balance have been shown to have lower rates of depression and drug use.

Discuss risky behaviors (such as sexual activity and substance use) and their consequences. Be sure to set a positive example yourself. This can help teens consider or rehearse decision-making ahead of time and prepare for when situations arise.

Honor independence and individuality. This is all part of moving into early adulthood. Always remind your child you are there to help when needed.

The adolescent years can feel like riding a roller coaster. By maintaining positive and respectful parent-child relationships during this period, your family can (try to) enjoy the ride.

Every child experiences changes at a different rate. If you’re concerned about your child’s rate of development or you have concerns about your child’s changing body, thinking or behavior, you could start by talking to a school counselor or your doctor. If you’re really worried, you could look for a counselor or psychologist. You don’t need a referral, but you might prefer to have your doctor recommend someone.

Physical development in adolescence

Puberty

Puberty is the time in life when a boy or girl becomes sexually mature. Puberty is a process that usually happens between ages 10 and 14 for girls (can start as early as age 6 or 7) and ages 12 and 16 for boys (can start as early as age 9). Puberty causes physical changes, and affects boys and girls differently. These physical, psychological and emotional changes signal your child is moving from childhood to adolescence. Most girls finish puberty by age 14. Most boys finish puberty at age 15 or 16.

There’s no way of knowing exactly when your child will start puberty. Early changes in your child’s brain and hormone levels can’t be seen from the outside, so it’s easy to think that puberty hasn’t started.

Puberty is a process. It occurs for several years. Puberty can be completed in about 18 months, or it can take up to five years. This range is also completely normal.

Puberty is made up of a clear sequence of stages, affecting the skeletal, muscular, reproductive, and nearly all other bodily sys­tems. Physical changes during puberty tend to be more gradual and steady. This is comforting to many parents who feel childhood passes much too quickly.

Changes in puberty include:

• physical growth and development inside and outside children’s bodies
• changes to children’s sexual organs
• brain changes
• social and emotional changes.

Girls key physical changes in puberty:

• The first sign of puberty is usually breast development.
• Then hair grows in the pubic area and armpits.
• Acne can occur.
• Menstruation (or a period) usually happens last.

If you have a daughter, these are the main external physical changes in puberty that you can expect.

• Around 10-11 years
  • Breasts will start developing. This is the first visible sign that puberty is starting. It’s normal for the left and right breasts to grow at different speeds. It’s also common for the breasts to be a bit tender as they develop. If your child wants a bra, a soft crop top or sports bra can be a good first choice.
  • Your daughter will have a growth spurt, and she’ll get taller. Some parts of her body – like her head, face and hands – might grow faster than her limbs and torso. This might leave her looking out of proportion for a while. On average girls grow 5-20 cm. They usually stop growing at around 16-17 years.
  • Your daughter’s body shape will change. For example, her hips will widen.
  • Your daughter’s external genitals (vulva) and pubic hair will start to grow. Her pubic hair will get darker and thicker over time.
• Around 12-14 years (about two years after breast development starts)
  • Hair will start growing under your daughter’s arms.
  • Your daughter will get a clear or whitish discharge from her vagina for several months before her periods start. If the discharge bothers your daughter, you could suggest she uses a panty liner. If your daughter says she has itching, pain or a bad or strong odor, check with a doctor.
  • Periods will start. This is when the lining of the uterus (womb), including blood, is shed every month. Your daughter might get pain before and during her period, like headaches or stomach cramps. Her periods might be irregular at first.

Boys key physical changes in puberty:

• Puberty usually begins with the testicles and penis getting bigger.
• Then hair grows in the pubic area and armpits.
• A small amount of breast tissue develops.
• The voice deepens.
• Muscles grow and strengthen.
• Acne can occur.
• Facial hair appears.

If you have a son, these are the main external physical changes in puberty that you can expect.

• Around 11-13 years
  • The external genitals (penis, testes and scrotum) will start to grow. It’s normal for one testis to grow faster than the other. You can reassure your son that men’s testes usually aren’t the same size.
  • Pubic hair will start to grow. It will get darker and thicker over time.
• Around 12-14 years
  • Your son will have a growth spurt. He’ll get taller and his chest and shoulders will get broader. Some parts of his body – like his head, face and hands – might grow faster than his limbs and torso. This might leave him looking out of proportion for a while. On average boys grow 10-30 cm. They usually stop growing at around 18-20 years.
  • It’s common for boys to have minor breast development. If your son is worried by this, you can let him know it’s normal and usually goes away by itself. If it doesn’t go away or if your son’s breasts seem to be growing a lot, he could speak to his doctor.
• Around 13-15 years
  • Hair will start growing on other parts of your son’s body – under his arms, on his face and on the rest of his body. His leg and arm hair will thicken. Some young men will grow more body hair into their early 20s.
  • Your son will start producing more testosterone, which stimulates the testes to produce sperm.
  • Your son will start getting erections and ejaculating (releasing sperm). During this period, erections often happen for no reason at all. Just let your son know that this is normal and that people don’t usually notice. Ejaculation during sleep is often called a ‘wet dream’.
• Around 14-15 years
  • The larynx (‘Adam’s apple’ or voice box) will become more obvious. Your son’s larynx will get larger and his voice will ‘break’, eventually becoming deeper. Some boys’ voices move from high to low and back again, even in one sentence. This will stop in time.

Both boys and girls may get acne. They also usually have a growth spurt (a rapid increase in height) that lasts for about 2 or 3 years. This brings them closer to their adult height, which they reach after puberty.

Not all children follow the same pattern of sexual development. Some girls develop breasts at a very young age but have no other signs of sexual development. Some children have pubic and armpit hair long before they show other signs of sexual growth. These changes in pattern are common. However, it’s a good idea for your child to have a check-up with his or her doctor once a year as he or she grows. This gives your doctor a chance to track the changes. Also, it gives you and your child a chance to ask questions.

Changes in body composition and height

Most children have a slimmer appearance during middle child­hood than they did during the preschool years. This is due to shifts in the accumulation and location of body fat. As a child’s entire body size increases, the amount of body fat stays relatively stable, giving her a thinner look. Also during this stage of life, a child’s legs are longer in pro­portion to the body than they were before. On average, the steady growth of middle childhood results in an increase in height of a little over 2 inches a year in both boys and girls. Weight gain aver­ages about 6.5 pounds a year.

A number of fac­tors, including how close the child is to puberty, will determine when and how much a child grows. In general, there tends to be a period of a slightly increased growth rate between ages 6 and 8. This may be accompanied with the appearance of a small amount of pubic hair, armpit hair, mild acne, and/or body odor.

The influence of heredity

Perhaps more than any other factor, your child’s growth and ultimate height will be influenced by heredity. While there are exceptions, tall parents usually have tall children, and short parents usually have short children. Those are the realities of genetics.

Concerns about growth

If your child seems unusually short or tall relative to his friends the same age, talk with your pediatrician. A true growth disorder can sometimes be treated by administering growth hormones; however, this therapy is re­served for young children whose own glands cannot produce this hormone. Doctors do not recommend this treatment for healthy boys and girls who may want (or whose parents may want them) to grow to be 6 feet tall instead of 5 feet 8.

Precocious puberty and delayed puberty

Most of the time, puberty follows the same age ranges. However, there is such a thing as precocious puberty (early onset) and delayed puberty.

• Precocious puberty:
  • In most cases, early puberty is just a variation of normal puberty. In a few cases, there may be a medical reason for it.
  • Talk to a doctor when a young girl develops breasts and pubic hair before age 7 or 8.
  • Talk to a doctor if a young boy has an increase in testicle or penis size before age 9.
• Delayed puberty:
  • Sometimes, delayed puberty is caused by a medical reason. For example, malnutrition (not eating enough of the right kinds of food) can cause delayed puberty. Both early and late puberty can run in families.
  • Puberty may be late in girls who have the following signs:
    • No development of breast tissue by age 14.
    • No periods for 5 years or more after the first appearance of breast tissue.
  • Puberty may be late in boys who have the following signs:
    • No testicle development by age 14.
    • Development of the male organs isn’t complete 5 years after they first show signs of development.

Talk to your child’s doctor about possible causes for the change in puberty pattern. Your doctor may do a physical exam. He or she might suspect a cause for the puberty variation and order some tests, including:

• Blood tests to check hormone levels.
• An X-ray of the wrist to check bone growth.
• A CT or MRI (imaging) of the head to look for a tumor or brain injury.
• Chromosome (gene) studies.

Sometimes the cause can’t be found even after several tests. When no cause is found, no treatment is needed. In some children, a medical cause is found and treated. For example, if the reason for late puberty is lack of hormones, hormone medication can help.

Teenage brain development

As children become teenagers, their brains grow and change. These changes affect their thinking and behavior.

Children’s brains have a massive growth spurt when they’re very young. By the time they’re six, their brains are already about 90-95% of adult size. But the brain still needs a lot of remodeling before it can function as an adult brain. This brain remodeling happens intensively during adolescence, continuing into your child’s mid-20s.

Some brain changes happen before puberty, and some continue long after. Brain change depends on age, experience and hormonal changes in puberty.

So even though all teenagers’ brains develop in roughly the same way at the same time, there are differences among individual teenagers. For example, if your child started puberty early, this might mean that some of your child’s brain changes started early too.

Inside the teenage brain

Adolescence is a time of significant growth and development inside the teenage brain. The main change is that unused connections in the thinking and processing part of your child’s brain called the grey matter are ‘pruned’ away. At the same time, other connections are strengthened. This is the brain’s way of becoming more efficient, based on the ‘use it or lose it’ principle.

This pruning process begins in the back of the brain. The front part of the brain, the prefrontal cortex, is remodeled last. The prefrontal cortex is the decision-making part of the brain, responsible for your child’s ability to plan and think about the consequences of actions, solve problems and control impulses. Changes in this part continue into early adulthood.

Because the prefrontal cortex is still developing, teenagers might rely on a part of the brain called the amygdala to make decisions and solve problems more than adults do. The amygdala is associated with emotions, impulses, aggression and instinctive behavior.

Have you noticed that sometimes your child’s thinking and behavior seems quite mature, but at other times your child seems to behave or think in illogical, impulsive or emotional ways? The back-to-front development of the brain explains these shifts and changes – teenagers are working with brains that are still under construction.

Building a healthy teenage brain

The combination of your child’s unique brain and environment influences the way your child acts, thinks and feels. For example, your child’s preferred activities and skills might become ‘hard-wired’ in the brain.

How teenagers spend their time is crucial to brain development. So it’s worth thinking about the range of activities and experiences your child is into – music, sports, study, languages, video games. How are these shaping the sort of brain your child takes into adulthood?

You are an important part of your child’s environment. You mean a lot to your child. How you guide and influence him will be important in helping your child to build a healthy brain too.

You can do this by:

• encouraging positive behavior
• promoting good thinking skills
• helping your child get lots of sleep.

Behavior strategies for teenage brain development

While your child’s brain is developing, your child might:

• take more risks or choose high-risk activities
• express more and stronger emotions
• make impulsive decisions.

Here are some tips for encouraging good behavior and strengthening positive brain connections:

• Let your child take some healthy risks. New and different experiences help your child develop an independent identity, explore grown-up behavior, and move towards independence.
• Help your child find new creative and expressive outlets for her feelings. She might be expressing and trying to control new emotions. Many teenagers find that doing or watching sport or music, writing and other art forms are good outlets.
• Talk through decisions step by step with your child. Ask about possible courses of action your child might choose, and talk through potential consequences. Encourage your child to weigh up positive consequences or rewards against negative ones.
• Use family routines to give your child’s life some structure. These might be based around school and family timetables.
• Provide boundaries and opportunities for negotiating those boundaries. Young people need guidance and limit-setting from their parents and other adults.
• Offer frequent praise and positive rewards for desired behavior. This reinforces pathways in your child’s brain.
• Be a positive role model. Your behavior will show your child the behavior you expect.
• Stay connected with your child. You’ll probably want to keep an eye on your child’s activities and friends. Being open and approachable can help you with this.
• Talk with your child about his developing brain. Understanding this important period of growth might help your child process his feelings. It might also make taking care of his brain more interesting.

Thinking strategies for teenage brain development

Brain growth and development during these years mean that your child will start to:

• think more logically
• think about things more abstractly and understand that issues aren’t always simple
• pick up more on other people’s emotional cues
• solve complex problems in a logical way, and see problems from different perspectives
• get a better perspective on the future.

You can support the development of your child’s thinking with the following strategies:

• Encourage empathy. Talk about feelings – yours, your child’s and other people’s. Highlight the fact that other people have different perspectives and circumstances. Reinforce that many people can be affected by one action.
• Emphasize the immediate and long-term consequences of actions. The part of the brain responsible for future thinking (the prefrontal cortex) is still developing. If you talk about how your child’s actions influence both the present and the future, you can help the healthy development of your child’s prefrontal cortex.
• Try to match your language level to the level of your child’s understanding. For important information, you can check your child has understood by asking him to tell you in his own words what he’s just heard.
• Help your child develop decision-making and problem-solving skills. You and your child could work through a process that involves defining problems, listing options, and considering outcomes that everyone is happy with. Role-modelling these skills is important too.

Sleep and teenage brain development

During the teenage years, your child’s sleep patterns will change. This is because the brain produces melatonin at a different time of the day. This makes your child feel tired and ready for bed later in the evening. It can keep your child awake into the night and make it difficult for her to get up the next morning.

Sleep is essential to healthy brain development. Try the following tips:

• Ensure your child has a comfortable, quiet sleep environment.
• Encourage ‘winding down’ before bed, away from screens including phones.
• Reinforce a regular sleeping routine. Your child should aim to go to bed and wake up at regular times each day.
• Encourage your child to get enough sleep each night. On average, teenagers need 8-10 hours each night.

Risk-taking behavior and the teenage brain

The teenage brain is built to seek out new experiences, risks and sensations – it’s all part of refining those brain connections.

Also, teenagers don’t always have a lot of self-control or good judgment and are more prone to risk-taking behavior. This is because the self-monitoring, problem-solving and decision-making part of the brain – the prefrontal cortex – develops last. Hormones are also thought to contribute to impulsive and risky behavior in teenagers. Teenagers need to take risks to grow and develop. You can support your child in choosing healthy risks – like sports and travel – instead of negative ones like smoking and stealing. All risk-taking involves the possibility of failure. Your child will need your support to get over any setbacks.

Stress and the teenage brain

With so many changes happening to your child’s brain, it’s especially important that your child is protected and nurtured. The incidence of poor mental health increases during the teenage years. It’s thought this could be related to the fact that the developing brain is more vulnerable to stress factors than the adult brain.

Teenage stresses can include alcohol and other drugs, high-risk behavior, experiences like starting a new school and peer pressure, or major life events like moving house or the death of a loved one. But too much protection and attention might not be good for your relationship either.

Instead, staying connected and involved in your child’s life can help you to learn more about how your child is coping with stress. It can also help you keep an open relationship with your child and ensure that your child sees you as someone to talk to – even about embarrassing or uncomfortable topics.

It’s thought that children are more likely to be open to parental guidance and monitoring during their teenage years if they’ve grown up in a supportive and nurturing home environment.

Every teenage child is unique, and teenagers respond to stress in different and unique ways. You know your child best, so it’s OK to trust your instinct on how to support your child if he’s going through a stressful time. It’s also OK to ask for help from friends, family members or professionals like your doctor.

Social development in adolescence

Identity

Young people are busy working out who they are and where they fit in the world. You might notice your child trying out new things like clothing styles, music, art or friendship groups. Friends, family, media, culture and more shape your child’s choices in these years.

Independence

Your child will probably want more independence about things like how he gets to places, how he spends his time, who he spends time with, and what he spends money on. As your child becomes more independent, it’ll probably mean some changes in your family routines and relationships, as well as your child’s friendships.

Responsibility

Your child might be keen to take on more responsibility both at home and at school. This could include things like cooking dinner once a week or being on the school council.

New experiences

Your child is likely to look for new experiences, including risky experiences. This is normal as your child explores her own limits and abilities, as well as the boundaries you set. She also needs to express herself as an individual. But because of how teenage brains develop, your child might sometimes struggle with thinking through consequences and risks before he tries something new.

Values

This is the time your child starts to develop a stronger individual set of values and morals. She’ll question more things, and she’s also learning that she’s responsible for her own actions, decisions and consequences. Your words and actions help shape your child’s sense of ‘right’ and ‘wrong’.

Influences

Your child’s friends and peers might influence your child, particularly his behavior, appearance, interests, sense of self and self-esteem. You still have a big influence on long-term things like your child’s career choices, values and morals.

Sexual identity

Your child might start to have romantic relationships or go on ‘dates’. But these aren’t always intimate relationships. For some young people, intimate or sexual relationships don’t occur until later on in life.

Media

The internet, mobile phones and social media can influence how your child communicates with friends and learns about the world.

Emotional development in adolescence

Moods and feelings

Your child might show strong feelings and intense emotions, and her moods might seem unpredictable. These emotional ups and downs can lead to increased conflict. They happen partly because your child’s brain is still learning how to control and express emotions in a grown-up way.

Sensitivity to others

As your child gets older, he’ll get better at reading and understanding other people’s emotions. But while your child is developing these skills, he can sometimes misread facial expressions or body language.

Self-consciousness

Teenage self-esteem is often affected by appearance – or by how teenagers think they look. As your child develops, she might feel self-conscious about her physical appearance. She might also compare her body with those of friends and peers.

Decision-making

Your child might go through a stage where he seems to act without thinking a lot of the time. Your child’s decision-making skills are still developing, and he’s still learning that actions have consequences and even risks sometimes.

Changes in relationships in adolescence

One of the big changes you might notice is that your child wants to spend more time with friends and peers and less time with family.

At the same time, it might seem like you and your child are having more arguments. This is normal, as children seek more independence. It’s also because your child is starting to think more abstractly and to question different points of view. On top of this, your child might upset people without meaning to, just because she doesn’t always understand how her words and actions affect other people.

It might help to know that conflict tends to peak in early adolescence and that these changes show that your child is maturing. Even if you feel like you’re arguing with your child a lot now, it isn’t likely to affect your relationship with your child in the longer term. But it might be a good idea to develop some ways of managing conflict to help you through this stage in your relationship.

Adolescence stage

Early Adolescence (ages 10 to 13)

During this stage, children often start to grow more quickly. They also begin notice other body changes, including hair growth under the arms and near the genitals, breast development in females and enlargement of the testicles in males. They usually start a year or two earlier in girls than boys, and it can be normal for some changes to start as early as age 8 for females and age 9 for males. Many girls may start their period at around age 12, on average 2-3 years after the onset of breast development.

These body changes can inspire curiosity and anxiety in some―especially if they do not know what to expect or what is normal. Some children may also question their gender identity at this time, and the onset of puberty can be a difficult time for transgender children.

Early adolescents have concrete, black-and-white thinking. Things are either right or wrong, great or terrible, without much room in between. It is normal at this stage for young people to center their thinking on themselves called “egocentrism”. As part of this, preteens and early teens are often self-conscious about their appearance and feel as though they are always being judged by their peers.

Pre-teens feel an increased need for privacy. They may start to explore ways of being independent from their family. In this process, they may push boundaries and may react strongly if parents or guardians reinforce limits.

Middle Adolescence (ages 14 to 17)

Physical changes from puberty continue during middle adolescence. Most males will have started their growth spurt, and puberty-related changes continue. They may have some voice cracking, for example, as their voices lower. Some develop acne. Physical changes may be nearly complete for females, and most girls now have regular periods.

At this age, many teens become interested in romantic and sexual relationships. They may question and explore their sexual identity―which may be stressful if they do not have support from peers, family, or community. Another typical way of exploring sex and sexuality for teens of all genders is self-stimulation, also called masturbation.

Many middle adolescents have more arguments with their parents as they struggle for more independence. They may spend less time with family and more time with friends. They are very concerned about their appearance, and peer pressure may peak at this age.

The brain continues to change and mature in this stage, but there are still many differences in how a normal middle adolescent thinks compared to an adult. Much of this is because the frontal lobes are the last areas of the brain to mature―development is not complete until a person is well into their 20s! The frontal lobes play a big role in coordinating complex decision making, impulse control, and being able to consider multiple options and consequences. Middle adolescents are more able to think abstractly and consider “the big picture,” but they still may lack the ability to apply it in the moment. For example, in certain situations, kids in middle adolescence may find themselves thinking things like:

• “I’m doing well enough in math and I really want to see this movie… one night of skipping studying won’t matter.”
• Do I really have to wear a condom during sex if my girlfriend takes the pill?”
• “Marijuana is legal now, so it can’t be that bad.”

While they may be able to walk through the logic of avoiding risks outside of these situations, strong emotions often continue to drive their decisions when impulses come into play.

Late Adolescents (18-21 and beyond)

Late adolescents generally have completed physical development and grown to their full adult height. They usually have more impulse control by now and may be better able to gauge risks and rewards accurately. In comparison to middle adolescents, youth in late adolescence might find themselves thinking:

• “While I do love Paul Rudd movies, I need to study for my final.”
• “I should wear a condom…even though my girlfriend is on birth control, that’s not 100% in preventing pregnancy.”
• “Even though marijuana is legal, I’m worried about how it might affect my mood and work/school performance.”

Teens entering early adulthood have a stronger sense of their own individuality now and can identify their own values. They may become more focused on the future and base decisions on their hopes and ideals. Friendships and romantic relationships become more stable. They become more emotionally and physically separated from their family. However, many reestablish an “adult” relationship with their parents, considering them more an equal from whom to ask advice and discuss mature topics with, rather than an authority figure.