Wellness

The term "wellness" is often used to describe the efforts we make in regards to taking care of our physical and spiritual well-being. Wellness may be associated with particular activities that promote good health, such as; smoking cessation programs, diets, meditation, aerobics training or yoga. If we are fortunate, we are able to incorporate these activities into our daily lives and affect an overall lifestyle change. Ultimately, the context of wellness addresses our desire to be healthy adults.

In addition, the term wellness might also be used in the context of how we envision young children becoming healthy adults. We often address this in terms of specific skills children need to acquire in order to be successful however, we might also consider this in the context how to support the development of healthy personalities in young children. What personality traits or attributes do young children need to develop to become healthy adults? Here are six to consider:

Sense of Future When children have a sense of the future they know they have choices. They can construct an image in their mind that helps them see what's ahead . . . and that things are going to turn out alright. We associate vision, wisdom and patience with a sense of future.

Sense of Appreciation Children appreciate what they have and also demonstrate value in others. They try to know and understand who others are. We associate sensitivity, acceptance, respect and inclusion with a sense of appreciation.

Sense of Togetherness Children spend time with others engaged in meaningful activities where they interact and participate together. We associate cooperation and trust with time together.

Sense of Emotional Balance Children find healthy ways to moderate their emotional and physical reactions to stressful situations. We associate stability and discipline with managing stress.

Sense of Open Communication Children listen and learn . . . and are genuinely interested in what others are saying. We associate expression, listening and interest with communication.

Sense of Commitment Children set goals for themselves and realize them even under adversity. We associate integrity and confidence with a sense of commitment.

We can teach specific skills that will help children develop their social, emotional, language and cognitive abilities. However, in regards to promoting wellness in the context of children's healthy personality, look to your childcare environment to determine whether it reflects the values or attributes we seek to instill in young children. Are children treated with wisdom and patience, cooperation and trust, stability and limits, openness and interest or integrity and confidence during their childcare experience? Providing a childcare experience that promotes these qualities or attributes is the most appropriate way to assure the development of children's emotional health and well-being.

Rewards

Whether in conjunction with a behavior program or in our everyday interactions with young children, we employ different methods to reinforce or reward behavior. The most common and effective method is for caregivers to target their attention and affection to children for appropriate behavior. More on this later.

One method employed by caregivers to reward or reinforce behavior is the use of tangibles. A tangible, by definition, is something that is real. . . something that can be touched, appraised or valued. One popular tangible used by caregivers are stickers. These are awarded to children when they participate, cooperate or just for a job well done. Stickers provide immediate rewards for children's behavior however, they have little intrinsic value and tend not to be able to reinforce behavior over the long term. Once given, stickers quickly lose their importance and, contrary to definition, they quickly become unstuck. Hand stamps or stick-on tattoos can also be used to reward compliance but their power to affect behavior soon fades as well. Another method using tangibles is the prize box or the "Treasure Chest". These are generally used by caregivers to reward children for appropriate behavior over an extended period of time, for example a day or, more often, a week at a time. However, an arbitrary schedule of rewards may not be appropriate for many children beset with problem behavior as they may require more immediate or frequent rewards to support their needs. They often experience feelings of loss as their peers are awarded prizes and they are not. Unfortunately, these feelings will have an overall negative impact on behavior. Food or sweets are often used as tangible rewards for appropriate behavior. Like stickers, they are useful as immediate rewards but have little long term value once ingested. For health and dietary reasons alone, sweets are a poor choice to reward or reinforce behavior.

While we might consider the manner in which a caregiver attends to or demonstrates affection for children as an intangible, don't underestimate it's importance in affecting behavior. Children respond to these intangibles as an affirmation of the value we ascribe them as individuals of worth, competence and capacity. These gestures are reassuring to young children whose emerging developmental skills may leave them ill-prepared for the vicissitudes of the childcare environment, particularly for children experiencing problem behavior. Therefore, the personal relationship caring adults establish with children will have a more potent effect on behavior than any tangible reward we could offer. Moreover, the success of most relationships doesn't depend on material goods or things, but flourishes because it provides each individual the opportunity to participate in or contribute to the relationship in some meaningful way. Therefore, if you are looking to reward or reinforce children's behavior, what you can give them is an opportunity to contribute consequentially to your childcare activities. Be creative in what opportunities you provide children in regards to playing a significant role in childcare activities as a result of appropriate behavior. Recognize, as well, that you probably provide some opportunities at present, but not realize it. These opportunites may be called; door holder, line leader, flag holder, weather spotter or table setter. Although we may consider these opportunities to participate routine, children do not.

Children should always have occasions to contribute in significant ways to their childcare experience. However, for children experiencing problem behavior, providing additional opportunities that celebrate their strengths and abilities will have lasting benefits. And, what better way to celebrate than in partnership with a caring adult.

Get With the Program, Part III

After devoting my last two posts to behavior programs, I recognized I should have stated at the very beginning that I seldom use behavior programs to address behavior problems with young children. In fact, hardly ever and typically only with individual children. If you are consistent in your efforts to recognize appropriate behavior, there is not usually a need to develop a structured program to guide your interactions with children. In addition, the attention and affection we provide children when appropriate is usually all that is needed to reward or reinforce behavior. Young children may also have a difficult time understanding how a behavior program operates or, simply, they lack the interest needed participate in a program successfully. Often I find that exceptionally bright or perceptive preschoolers respond best to individual behavior programs.

Like many things in life, the motto "Keep it simple, make it fun" applies to behavior programs. In addition, for any program to work, care-givers must be invested in the success of the program and diligent in their efforts to implement it consistently each and every day. If you don't think it is important, worthwhile or fun, neither will the children. Again, I suggest that care-givers follow their daily schedule and take the opportunity to reflect with children about their behavior during transitions from one activity to another (see Get With the Program, Part II). This doesn't take long and can easily become a part of your normal daily interactions with children. Identify the total number of transitions possible from activities listed your daily schedule (let's say 12) and determine a level of success (let's say 6) that a child can achieve daily in their target behavior (let's say Safe Hands). That is, we expect children in this instance to be able to use their safe hands during at least 6 of 12 scheduled activities. For some children the level of success may be set higher, for some, the level may actually be lower. Most importantly, caregivers need to determine a level where children will experience success. If we develop unrealistic goals for children's performance our behavior program is doomed to failure. We start at achievable levels and increase expectations over time. Before you start a behavior program, let children know how the program works and the expectations for success.

Caregivers can have children chart their success with the target behavior by placing a check mark next to the activity on their daily schedule. An alternative system utilizes "tokens", such as poker chips, that are awarded to children during transitions and then deposited in a "bank". At the end of the day, the parent or caregiver can check children's progress and determine whether they had met their goal regarding the target behavior. Again, we eliminate the issue of making arbitrary decisions whether children have been good or bad and focus instead on measurable performance regarding the target behavior. Finally, be careful not to use behavior programs to threaten children, such as "You won't get a token if you keep that up!" or to penalize children for inappropriate behavior by taking away check marks or tokens earned. If there's a problem engaging in the target behavior, children will fail to earn a check mark or a token but always have the opportunity to redeem themselves and earn more. If children successfully engage in the appropriate target behavior but experience other behavior problems, they still earn a check mark or token but may face a consequence for their other misbehavior. A behavior program is like a contract with children, we can't be changing our stated expectations in response to other problems.

Get With The Program, Part II

In my last post, I reviewed how caregivers typically use behavior programs to provide children with consequences for their misbehavior. However, I believe that behavior programs are most effective when used to provide a structure for caregivers to reinforce children's appropriate behavior.

I think it is important that subjective views regarding children's overall behavior be eliminated from behavior programs. My approach is to address one behavior at a time or to "target" a particular behavior. This helps to clarify the problem and move the focus from moral judgements regarding whether children have been good or bad, to particular actions or behaviors happening in real time. While there may be many behaviors that create problems, addressing one behavior at a time communicates to children that you place particular importance on that behavior and helps support a consistent approach in your efforts to address the behavior. Furthermore, if you believe a rising tide raises all boats, any improvement in the "target" behavior will be generalized to other behaviors.

Always define behavior, target or otherwise, in terms of a desired outcome. For example, if behavior is exhibited as hitting or pushing, "target" children's use of "safe hands". If the problem behaviors are running or screaming, "target" behaviors would include the use of "walking feet" and "quiet voices". In any event, whether you are using a behavior program or not, helping children focus in a positive way on their appropriate behavior will pay off in spades.

Even for children who experience significant problems in their preschool environment, the vast majority of time they are engaging in appropriate behavior or, at least, an absence of inappropriate behavior. Unfortunately, we often fail to recognize and reinforce this behavior when it occurs. A behavior program is used to provide a schedule for caregivers to interact with children regarding their appropriate behavior at regular intervals throughout the day. In the daycare environment, the classroom schedule can be used to guide this interaction. As children transition from one activity to another, have them assess whether they had engaged in the "target" behavior during the preceding activity. This is not a question of whether you have been good or bad, but whether you used your "safe hands" during, for example, circle time . Children are always given the first opportunity to determine whether they had engaged in the target behavior or not. In this way, we allow children ownership in the program, as well as control over behavioral outcomes.

In an earlier post, I addressed the difficulty children have being circumspect about their behavior. So, don't be surprised when they won't acknowledge that they weren't able to engage successfully in the target behavior during the time defined by the program. We can then provide a supportive "reality check" with children to determine whether they engaged in the target behavior or not. In my next post, I'll address scoring behavior programs and rewarding children for meeting behavioral goals.

Get With The Program

Many child care providers utilize classroom behavior programs as a tool to influence children's behavior. Behavior programs can be as simple as using stickers to reinforce appropriate behavior to more sophisticated programs that monitor the quality of children's behavior over time using quantitative measures. These might include the use of check marks on a daily schedule, popsicle sticks placed in an envelope or, for one program I recently encountered, hole punches on an index card. Providers sometimes incorporate colors into behavior programs, for example, using the spectrum of a traffic light to denote behavioral expectations . . . green for go, yellow for slow down and red for stop. At home, behavior programs are often used in conjunction with "potty" training to support children's transition to independent toileting.

Unfortunately, many classroom behavior programs appear to be structured solely to provide a punitive response to inappropriate behavior. Often a program stands by idle or inert until misbehavior occurs, then is activated to impose a negative consequence on a child or to threaten an impending consequence. However, threats and negative outcomes are apt to increase children's levels of stress and, consequently, contribute to misbehavior. Indeed, an abrupt loss of status in a behavior program may actually trigger an outburst or tantrum. It will certainly signal trouble ahead if children perceive that a loss in program status is equivalent to "all is lost".

Recognize that young children have difficulty understanding how to integrate their behavior into an emerging concept of self. Because they tend to think in concrete terms, children may have a difficult time separating what they do from who they are. Therefore, behavior programs that focus exclusively on providing consequences for misbehavior may be contributing to feelings of loss and low self-esteem. In children's eyes, a behavior program may appear primarily as an indicator of their "goodness" or "badness" (see my post, No Bad Kids). Moreover, some care-givers may reinforce this impression of good or bad by using symbols in their behavior program that create either positive or negative associations, such as smiley faces versus "frowny" faces or promoting such concepts as green means good and red means bad. Sometimes we'll use a program to label behavior outright, leaving no doubt what we consider good or bad.

Our ability to effect children's behavior is greatly diminished when we approach these programs only as tools to consequence misbehavior. When control of the program is administered by the caregiver, there is little motivation for children to make an effort to modify their behavior or, moreover, participate in the program in any meaningful way. For behavior programs to be successful, they should provide frequent opportunities for providers to interact with young children regarding appropriate behavior, as well as provide children with opportunities to participate in the program in meaningful ways. More on this in my next post.

Teams

I have been somewhat neglectful in keeping up my posts of late, as some of you have pointed out to me. It seems that I am busier than usual at this time of year and that many of the families of the children I have been seeing are in crisis and trying to manage as best they can under incredible stress. While this has often been the case with the children and families I have worked with over the years, it seems more so now, than ever before. I know in my day-to-day interactions with other care-givers, they have also expressed that the children we now serve present greater challenges than those in our care not so long ago.

Recently, I have been talking to a number of parents about the importance of "teams" in providing for the needs of children and families. The team approach is not only important in the assessment and delivery of services for children, but it provides a structure for care-givers to provide each other with mutual support, both professionally and emotionally, as they move forward. Generally, I see success as care-givers come together as team players in support of children and families. However, within the larger context of the local community I serve, we often seem unwilling or unable to come together to develop a positive environment in which to work on common goals and to provide mutual support. Attitudes range from anger, resentment and personal animosity to apathy, indifference and disinterest. We pursue what benefits our narrow interests, not what is in the best interest of everyone. We accept financial support and consider it an entitlement. We've come to expect a helping hand, but are unwilling to extend our hand in appreciation. We engage in the politics of personal destruction, attacking or denigrating those individuals or groups who disagree with us, even though they share our common goals. We complain bitterly, but can't be bothered to try to make a positive contribution. These attitudes seem to pervade our small community of providers and professionals. . . and we have come to accept and tolerate this behavior.

Our obligations to serve the needs of children and families in our community require us to find ways for us, as individuals, and the institutions we represent to work together with mutual respect. I offer these "Team Commandments" as a way that may help create a community of childcare providers, advocates and professionals who work together in a positive and supportive manner. They may help with your team too.

1. Speak positively about each other and about our organizations at every opportunity.

2. Help each other to be right, not wrong.

3. Look for ways to make things work, not for reasons they won't.

4. Help each other win, and take pride in each others victories.

5. Compliment often.

6. Recognize that your constituents are not an interruption to your work, but reason for it.

7. Realize that "being right" is irrelevant. It's other's perception that counts.

8. Maintain a positive mental outlook.

9. Sacrifice for the good of the team.

10. Participate and have fun.

Self-Injurious Behavior

As child care providers, we have grown accustomed to children who sometimes act aggressively toward others. There may be times, however, when we observe young children who engage in self-injurious behavior. Self-injurious behavior is usually associated with temper tantrums experienced by children under three years of age. Self-injurious behavior is often exhibited as head-banging . . . although some children have been observed to hit, bite or even to scratch themselves. When we encounter young children who exhibit this type of behavior, our initial reaction may be one of shock and dismay, often followed by uncertainty regarding how to appropriately respond to this behavior.

Tantrums are a result of intense feelings of anger or frustration overwhelming children's capacity for self-control, leaving feelings to be expressed, or acted-out, through their behavior. While tantrums can be quite dramatic, these outbursts often lack focus or organization . . . what we might describe as a "meltdown". At times, tantrums may be directed toward individuals or objects in the immediate environment and exhibited as unsafe or aggressive behaviors. These behaviors might include hitting and biting or the destruction of property, such as turning over chairs or tearing the pages of a storybook. Occasionally, young children will express these strong feelings through self-injurious behavior.

Closely monitor children's behavior whenever tantrums occur. If children act to injure themselves or others, our immediate response must be to ensure safety. In the case of self-injurious behavior, this may require that the provider intervene with children during their tantrum using gentle, physical redirection. Our aim is not to provide physical control of children during this time of stress, but to avert an action where children attempt, for example, to scratch or bite themselves. In the case of headbanging, gently placing your hand on or under the child's head will help limit the force of the impact. Another alternative would be to introduce a soft item, such as a pillow or mat, on which children might direct their behavior.

I usually refrain from interacting with children during temper tantrums unless their behavior presents a threat to themselves or others. My goal is to provide for safety and not to reinforce inappropriate behavior with undue attention. Recognize, however, with aggressive or self-injurious behaviors any attempts by a care-giver to exert physical control over children may actually escalate the behavior. A firm, respectful and supportive approach is best during these turbulent times. At every other time, focus on developing children's social and emotional skills, as well as other developmental abilities. This includes helping children explore feelings or emotions, develop problem-solving skills and using language to express needs. These skills are fundamental in helping children express strong feelings and to regulate their behavior. As these skills develop, the frequency and intensity of tantrums and associated behaviors should diminish.

Most care-givers exposure to self-injurious behavior will be in terms of typically developing children. In some cases, however, self-injurious behavior may be associated with severe developmental delays or indicative of a mental health problem. Be aware of self-injurious behavior not associated with tantrums or that may appear rhythmic or repetitive. In addition, be aware of more subtle behaviors, such as when children frequently pick at their skin or pull at their hair. This behavior may indicate problems if it results in open wounds, sores or hair loss. In particular, if you observe children using objects to cut or pierce their skin, seek immediate assistance.

Pull-Over Prophecies

In my visits to child care facilities over the years, I've spent a considerable amount of time observing children's behavior. However, I never paid much attention to what children were wearing, except to note whether their clothes were clean, in good condition and appropriate for the weather. Recently, I started to pay more attention to the messages that are incorporated into children's clothing. Many carry a statement or a label that, presumably, describes the child or the child's behavior or attitude. Out of curiosity, I started to record some of these descriptions.

Before reviewing the results of my survey of children's attire, allow me to make some broad generalizations about my observations of "child care wear". I would note that most young children wear pull-overs, which makes considerable sense due to their emerging fine motor skills and the challenges presented by buttons and zippers. Girls appear to wear more colorful clothing, such as pink or violet, that sometimes feature embroidery, sparkles or even rhinestones. Boys often wear solid colors, dark greens or blues, although camouflage or sports stripes are not unusual.

Whether or not a label or description imprinted on children's clothes represents an accurate portrayal of children or children's behavior, it often reflects care-giver's beliefs regarding those children. At one time, those beliefs might have been summed up in this way; "Girls are made of sugar and spice and everything nice, boys are made of snips and snails and puppy dog tails". Unfortunately, this old adage appears to be the recepient of a modern make-over, losing its innocent quality and taking a more indulgent view of children and their behavior. According to the labels I observed on children's clothes, girls are no longer "nice" but, "Adorable", an "Angel" or a "Princess", "It's All About Me" and "Small But Feisty". Boys are no longer like "puppy dog tails" but, "Mommy's Little Monster", "No Pain, No Game", "Allergic to my Sister", a "Commando" or "Nobody Knows the Trouble I've Been".

Attitudes or beliefs can be a powerful force that affect children's behavior. If a care-giver labels children as "Princesses" or "Trouble" or "Feisty", there will be a tendency by the care-giver to treat those children accordingly. If children are treated as "Princesses" or "Trouble" or "Feisty" , there will be a tendency by those children to act that way and, eventually, be that way. Thus, the care-giver creates a self-fulfilling prophecy where their belief about children becomes reality. Therefore, be aware of how your beliefs and attitudes toward children, particularly individual children, affect your demeanor and behavior.

For me, my attitude toward my work with young children and the people who care for them is as simple as the statement I observed on one little boy's shirt . . . it proclaimed; "Life is good".