Month: December 2021

As a doctor, I am constantly advising my patients to prioritize their own mental and physical health. Get adequate sleep. Eat healthy. Learn how to say no so you don’t collapse from exhaustion. Love and care for yourself like you do others.

I talk the talk but don’t always walk the walk — even though I know, both intellectually and physically, that self-care is critical to my well-being. When I am run down, my MS symptoms cry out for attention: left leg weakness and numbness, subtle vertigo, a distinct buzzing in my brain like a relentless mosquito that won’t go away no matter how many times I twitch and shake my head. I have become frighteningly good at ignoring these symptoms, boxing them up and pushing them away. Often, I can muscle through; other times it just hurts.

Recently, a friend challenged me to think about my relationship with my illness, to describe MS as a character in my story. This was a useful exercise. I conjured up an image of a stern teacher. She is frighteningly blunt and lets me know, loud and clear, when I disappoint her. She can be mean and scary, and I don’t really like her. But I must admit she is usually right. Still, I often defiantly dismiss her, even when part of me knows this is not in my best interest.

This holiday season, I wanted to do better. I needed to do better. So, as Thanksgiving approached, as I prepared to host 16 family members, many for multiple days, I paused to ask myself, What does MS have to teach me about self-care? I don’t like having this disease, but I do. I can’t change my reality, so I might as well benefit from the lessons MS is forcing on me. I believe they are relevant to all of us, whether we live with chronic illness or not, so I’ll share them here.

The first steps: Listen and observe

When my MS symptoms flare, it’s a message that I am tired, overextended, and stressed. I need to rest. I don’t always listen right away, but eventually I am forced to, and when I listen, I feel better. All of us can benefit from slowing down and tuning in to our physical selves. What sensations are you experiencing in your body, and what does this tell you about your underlying feelings and state of mind? Yes, we should heed our thoughts, but tuning in to our bodies takes us deeper, to feelings that might be hidden, secrets we might not want to acknowledge, a physical truth. If you don’t have a chronic illness, the messages might be more subtle — a vague tightness in your chest, a quick catch in your breath, a barely noticeable tremor in your hands — but they exist, and they signal stress.

The science is clear: the body’s stress response — though potentially lifesaving in a true emergency, when “fight or flight” is essential to survival — can be toxic in our everyday lives. Stress triggers our sympathetic nervous system to kick into overdrive in response to a perceived threat, releasing hormones such as cortisol and inflammatory molecules that, when produced in excess, fuel disease. Conversely, we know that pausing to take notice and interrupting this negative cycle of stress is beneficial. It can be as simple as breathing deeply and counting to 10. Our bodies know what’s up and let us know when we need to take care of ourselves. We must pay attention.

You are not responsible for everyone and everything

The holidays, essentially from mid-November through the end of the year, are a stress test we create for ourselves. The land mines are everywhere: more food, more drinking, more family dynamics, more unfamiliar (or overly familiar) surroundings. Personally, with my overinflated sense of responsibility, I experience a kind of dizzying performance anxiety every holiday season. I believe it is my job to make sure everyone present has a positive experience. For better or worse, I am someone who notices and feels the personal and interpersonal dynamics in a room. I sense and absorb even the most subtle discomfort, frustration, anger, shame, and insecurity, alongside the more upbeat emotions. Importantly, I also I feel the need to step in and make things better, to prop everyone up. It’s exhausting. But MS reminds me of how absurd, and even egotistical, this is. In truth, I can’t possibly care for everyone. Neither can you.

It helps to check our automatic thoughts. More than once on Thanksgiving Day, as the busy kitchen buzzed with activity and conversation, I intentionally stepped back and watched, reminding myself that I didn’t have to hold the whole thing up. Even though I inevitably slipped back into hyper-responsibility mode, these moments of self-awareness impacted my behavior and the dynamic in the room.

It’s okay to say what you need

To take full responsibility for my own well-being, I need to speak honestly and act with integrity. This means asking for what I need, clearly and without apology. Historically, I have been terrible at this in my personal life, burying my own needs in the name of taking care of everyone else’s, even rejecting clear offers of help. “I’m good, I’ve got it,” I might say, while simultaneously feeling bitter and resentful for having to do it all myself. This lack of clarity isn’t fair to anyone. MS reminds me that I need to do better.

This year, when my guests asked me what they could bring, I took them at their word and made specific requests instead of assuring everyone that I had it covered. When my mother started banging around in the kitchen at 7 a.m. with her endearing but chaotic energy, asking for this and that pot and kitchen utensil so she could start cooking, I told her I needed to sit down and have a cup of coffee first. She would need to wait or find things herself. She was okay with that. Family dynamics can be entrenched and hard to change, but clear communication can set new ways of being into motion, one baby step at a time.

I still have a lot to learn, but I am making stuttering progress, learning to listen to my body and honor my needs while also caring for those I love, or at least trying. Undeniably, I experienced some post-Thanksgiving fatigue, exacerbated by my daughter’s early-morning hockey game the next day, requiring a 4:30 a.m. departure. I felt it in my body — the familiar leg weakness, vertigo, and brain cobwebs — and, completely uncharacteristically, I took a nap.

During the first year of life, naps are crucial for babies (who simply cannot stay awake for more than a couple of hours at a time), and crucial for parents and caregivers, who need breaks from the hard work of caring for an infant.

But as children become toddlers and preschoolers, naps aren’t always straightforward. Children often fight them (following the “you snooze you lose” philosophy), and they can conflict with daily tasks (such as school pick-up when there are older siblings) or lead to late bedtimes.

Here are some tips for making naps work for you and your child — and for knowing when they aren’t needed anymore.

Making naps work for your baby

Most infants will take at least two naps during the day, and early in toddlerhood most children will still take both a morning nap and an afternoon nap. Naps are important not just for physical rest and better moods, but also for learning: sleep allows us to consolidate new information. As children get older, they usually drop one of the naps, most commonly the morning nap.

Every child is different when it comes to napping. Some need long naps, some do fine with catnaps, some will give up naps earlier than others. Even within the same family, children can be different. A big part of making naps work is listening to and learning about your child’s temperament and needs. Otherwise, you can end up fighting losing battles.

The needs of a parent or caregiver are also important: everyone needs a break. Sometimes those breaks are particularly useful at specific times of the day (like meal prep time). While you can’t always make a child be sleepy at the most convenient time for you, it’s worth a try — which leads me to the first tip:

Schedule the naps. Instead of waiting for a child to literally drop and fall asleep, have a regular naptime. We all do better when our sleep routines are regular, even adults. If you can, put the child down awake (or partially awake). Learning to fall asleep without a bottle or a breast, or without being held, is a helpful skill for children to learn and can lead to better sleep habits as they grow.

A couple of scheduling notes:

• If you need a child to fall asleep earlier or later than they seem to do naturally, try to adjust the previous sleep time. For example, if you need an earlier morning nap, wake the child up earlier in the morning. It may not work, but it’s worth a try.
• Naps later in the afternoon often mean that a child won’t be sleepy until later in the evening. That may not be a problem, but for parents who get tired early or need to get up early, it can be. Try to move the nap earlier, or wake the child earlier. If the problematic afternoon nap is in daycare, talk to the daycare provider about moving or shortening it.

Create a space that’s conducive to sleep. Some children can sleep anywhere and through anything, but most do best with a space that is quiet and dark. A white noise machine (or even just a fan) can also be helpful.

Don’t use screens before naptime or bedtime. The blue light emitted by computers, tablets, and phones can wake up the brain and make it harder for children to fall asleep.

When is it time to give up naps?

Most children give up naps between the ages of 3 and 5. If a child can stay up and be pleasant and engaged throughout the afternoon, they are likely ready to stop. Some crankiness in the late afternoon and early evening is okay; you can always just get them to bed earlier.

One way to figure it out, and ease the transition, is to keep having “quiet time” in the afternoon. Have the child go to bed, but don’t insist on sleep; let them look at books or play quietly. If they stay awake, that’s a sign that they are ready to stop. If they fall asleep but then end up staying up very late, that’s another sign that the afternoon nap needs to go.

Whether or not your child naps, having some quiet time without screens every afternoon is a good habit to get into. It gives your child and everyone else a chance to relax and unwind, and sets a placeholder not just for homework but also for general downtime as children grow — and just like naps for babies, downtime for big kids is crucial.

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All parents want their children to be successful in life — and by successful, we mean not just having a good job and a good income, but also being happy. And all parents wonder how they can make that happen.

According to Harvard’s Center on the Developing Child, it’s less about grades and extracurricular activities, and more about a core set of skills that help people navigate life’s inevitable challenges. These skills all fall under what we call executive function skills, which we use for self-regulation. Most people who are successful and happy in life have strong executive function skills.

What are five important core skills?

• Planning: being able to make and carry out concrete goals and plans
• Focus: the ability to concentrate on what’s important at a given time
• Self-control: controlling how we respond to not just our emotions but stressful situations
• Awareness: not just noticing the people and situations around us, but also understanding how we fit in
• Flexibility: the ability to adapt to changing situations.

While these are skills that children (and adults) can and do learn throughout their lifetimes, there are two time periods that are particularly important: early childhood (ages 3 to 5) and adolescence/early adulthood (ages 13 to 26). During these windows of opportunity, learning and using these skills can help set children up for success. In this post, we’ll talk about that second window of adolescence.

The best way to learn any skill is by actually doing it. Here are some suggestions for parents wondering how to help and when to step back.

Planning

When children are little, it’s natural for parents and caregivers to do the planning for them. But as children grow into teens, they need to learn to do it for themselves.

• Avoid micromanaging your teen’s life. Instead, set some ground rules — simple ones like: homework needs to get done, they need seven to eight hours of sleep, and regular exercise is important. You may have some other ground rules, like attending family meals or religious services. Then let your teen figure out how to get it done. Step in only if ground rules are clearly being broken consistently.
• When teens have long-term projects, such as a research project or college applications, sit and talk with them about how they want to get it done. Let them come up with ideas before you do!
• Involve your teens in planning family activities or vacations, home renovations, or other projects. Let them make some of the decisions (even if you don’t always agree).

Focus

The explosion of device use has caused all sorts of problems with focus in people of all ages. There is an instant gratification to screens that makes it hard to put them aside and focus on less stimulating tasks — so now, more than ever, it’s important to

• talk about how social media and the Internet can interfere with daily life (and homework), and help them come up with strategies to manage the distraction.
• have screen-free meals and family time.
• encourage hands-on activities that don’t involve screens, like cooking, baking, building things, sewing, crocheting, drawing, painting, or gardening.

Self-control

This is one where being mindful of your own reactions to situations is important. How do you react to anger and frustration? Is road rage a problem for you? Remember that our children always pay more attention to what we do than what we say. To help your teen learn self-control, you can:

• Talk about feelings, and about strategies for managing strong feelings — like taking a deep breath, stepping away from the situation, screaming into a pillow, etc.
• Debrief after upsets, once everyone has calmed down. What might your teen have done differently? What could they do next time?
• Talk about how their behavior affects others, and why it’s important to be mindful of that (a practice that also teaches awareness).

Awareness

Teens can be very aware — but mostly of their own world. Help them learn to see beyond that.

• Talk about current events and stories in the news. In particular, talk about how these affect people, and how different people might see them differently.
• Go places with your teen — even just a walk in the woods or a visit to a nearby town can give them opportunities to look around them and see things they might otherwise miss.
• Join community service activities as a family; show teens how they can make a difference.
• Have rituals of checking in as a family, like at dinner. Give everyone a chance to talk about their day.

Flexibility

Life throws curve balls all the time, and teens need to be able to adjust.

• Don’t be too rigid about your teen’s schedule. Help them prioritize, and see which things can be missed or postponed when something happens, good or bad.
• Encourage some spontaneity. This, too, is about learning to prioritize and not getting too stuck in routines.
• Be a role model. Be spontaneous yourself — and don’t get too upset when plans change. Make new plans.

Any time you let your teen do something, there is a reasonable chance that they will fail. Resist the urge to jump in right away. While it’s important to have your child’s back (now and for the rest of their life), sometimes teens need to fail in order to learn. Give them a chance to figure it out themselves before you offer help. They may just surprise you.

Breathe. Count to 10. Take a walk. These strategies have long been advised to help you pause and rethink your reaction when you’re seeing red and an inch away from exploding. Under normal circumstances — maybe a little stress at home or at work — those strategies can be useful. But you may find they’re less effective in the pressure cooker we’ve been living in since the pandemic began. What can you do to avoid reaching your boiling point?

For insight, I turned to psychologist Stuart Ablon, founder and director of Think:Kids in the department of psychiatry at Harvard-affiliated Massachusetts General Hospital. Ablon is an expert at defusing explosive behavior among kids and teens with severe developmental delays in problem solving, flexibility, and tolerance to frustration — the skills that keep us from melting down.

Pandemic stress blocks our coping abilities

Ablon says many adults are struggling with a lack of these skills right now — not because we haven’t developed them, but because pandemic stress is blocking them. “When we humans are chronically stressed, we lose access to the part of our brain that performs skills like flexibility and tolerance,” Ablon says.

Blocked skills can reduce our coping abilities to those of little children, like toddlers who scream when they don’t get their way.

Practice empathy

Ablon says it’s crucial to stay calm or “regulated” when you’re feeling mad or upset, so you can access the skills needed to maintain control. And the best way to remain calm, Ablon says, is by practicing empathy — trying to sense another person’s perspective or point of view.

“Empathy is the most powerful human regulator we have. It’s been proven to de-escalate people in the most challenging of prison settings, and it can also work on an airplane or in line at Starbucks,” Ablon says. “Think about it: when someone listens to you and tries to understand your point of view, it calms you. You can feel your heart rate drop.”

How does empathy help you?

Calming others is great, but how does being empathetic keep you from exploding? It has a domino effect.

• Trying to understand someone else's point of view may change your mind about how you want to react. It will also give you something important to do, which will keep you focused so you can remain calm.
• Being calm enables you to access coping skills like problem solving, flexibility, and tolerance to frustration.
• Accessing your coping skills strengthens your ability to keep your cool.
• Because you’re calm, you’ll keep someone else from exploding, which in turn helps you continue to stay calm.

Four steps to help you stop seeing red

To practice empathy, Ablon recommends the following steps.

• Adopt a mindset that people are doing the best they can. “We’re all trying our best to handle what the world is throwing at us, with the skills we’re able to access at that moment. None of us wants to be losing it,” Ablon says. “Think to yourself, ‘This person I’m interacting with isn’t giving me what I want, but this person is doing the best they can right now.’ If you can exude that, you will help regulate them. It’s incredibly contagious — the same way a parent who stays calm can soothe a crying baby, or a kindergarten teacher with supreme calmness can regulate a whole class.”
• Be curious, not furious. Ablon recommends asking questions without jumping to conclusions, so you can find out where people are coming from. What are their circumstances? What’s driven them to this moment? What do they need?
• Practice active listening. “One of the most powerful things you can do to regulate someone is to repeat back to them what you’re hearing from them in your own words. It makes them feel heard,” Ablon says. “So ask questions, and when you get information, reflect back what you’ve heard. It’s called active listening.”
• Offer reassurance. Remind the person you’re talking to that you’re trying to help. “Say, ‘I’m just trying to understand. I know you must have an important reason and I want to hear more. I’m not trying to get you upset. I want to work things out.’ That’s very calming and regulating,” Ablon says.

It may not be easy to remain empathetic in these challenging times. But the more you practice this skill, the more empathetic you’ll become. That can deliver significant results. “If you can stay calm and approach someone kindly and with understanding,” Ablon says, “it will head things off at the pass for both of you.”