Children’s Sleep

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Lil Bro: Mummy – I can’t sleep

Me: Please, its past nine o’clock, what are you doing still up? You have to go to sleep now or you’ll be exhausted at school tomorrow! [Plus I just got started on this week’s episode of “This is US” and a tub of ice cream and I really fancy a rest!]

Lil Bro: But I can’t sleep.

Me: Just close your eyes and lie still! [Grrr]

I’m sure many of you are nodding in sympathy at this experience. Lil Bro who usually has no difficulty getting to sleep is having a spate of “I can’t get to sleep”. We have tried cuddling, cajoling, comforting, reassuring and now we are at the frankly fed up stage.

Children with poor sleep can have difficulties with poor concentration, over-activity, behavioural problems, day-time sleepiness, bed-wetting, obesity, increased clumsiness, depression and worse academic performance. Equally bad, the lives of their parents and entire family are also grossly affected. As parents of infants, we have all been there, but somehow I’ve taken immense umbrage at this recent spell of poor sleep because Lil Bro is now 7 years old and well able to put himself to sleep.

When Big Sis was a wee mite, I was the rabid sleep-deprived mother heckling the sleep experts flown in from abroad to teach us doctors about sleep EEG’s: “Can you tell me why, WHY, how, HOW can a baby go from stage 4 deep sleep to AWAKE and CRYING just by a 10 degree tilt to lay them in the cot????!!!! Give me the EEG on how that happens…!!!! What’s the possible mechanism???!!!”….zzzzzzzz – bonk.

So, I must now be the envy of most mums, as for the last few years I have had the pleasure of working with Paul Gringras a.k.a. the Professor in charge of the national Sleep Medicine centre at The Evelina Children’s Hospital. I have been working with him on an international multi-centre drug trial for sleep medication in children with neurodisability (mainly autism), which he is leading. His centre is hi-tech with observational sleep bays where children can sleep-over and be observed on video to capture what is going on, often plugged into electronic equipment that monitors breathing, brain and movement activity and I was fortunate enough to be able to sit in on consultations with Consultant Paediatrician Dr Mike Farquhar. It all sounds very medical. What then has a shrink got to do with sleep?

Well, it turns out that the majority of sleep problems in children are “behavioural”. Yes, there are known medical causes of disturbed sleep, e.g. restless leg syndrome, obstructive sleep apnoea, sleep walking and so on, but for the majority of cases in children who are otherwise fit and well, it is what children and their parents are in the “habit” of doing that is keeping them all awake.

What constitutes a sleep problem?

The definition of a “good night’s sleep” is variable from person to person. As a student, a full 10 hours was a requisite for me often causing tardiness to morning lectures. At weekends waking before 10am was unheard of. As a junior doctor, 4 hours sleep constituted immense good fortune and developed in me the very useful skill of being able to sleep anywhere, anytime – zzzzzz-bonk. These skills came in handy with babies that hadn’t read Gina Ford. The early years of parenthood are a sleep-deprived blur, but once the youngest had reached the milestone of 3 years, a more acceptable routine of 10 hours of continuously sleeping children was established –albeit the 6am wakenings were still somewhat painful.

In reality sleep requirements differ between children of different ages, but also between different children. Average daily sleep duration ranges between 10-17 hours at 6 months to 8-11 hours at age 11 years. This variability colours people’s ideas of what constitutes a sleep problem, and I am often bemused by some parents who come in desperation seeking medication for 10 year old children that sleep from 7:30pm to 6am: thinking with a mix of incredulity “What planet are you on? That’s almost a full 11 hours!” and admiration “Please tell me how on earth you get a 10 year old to go to bed at 7:30pm!” With these children who are getting hours of sleep within the acceptable range, the sleep is only classified as problematic if it represents a dramatic change to sleep pattern and/ or if there is any evidence of daytime sleepiness. If the answer to both is “No”, then one should feel reassured. However, for a psychiatrist, we know that often a parental cry for help of “My children don’t sleep!” is actually a cry of “I’m struggling to cope with my children when they are awake!” This differentiation is critical as the treatment strategies for the two problems are entirely different.

Aside from these perceptual sleep problems, the three main problems involving sleep are: struggling to fall off to sleep, waking in the middle of the night and co-sleeping.

Struggling to fall off to sleep

Problems falling off to sleep are often cited as a struggle. Sleep latency (to give it its fancy name) averages 19 minutes in 0-2 year olds and 17 minutes for 3-12 year olds. Anything over 30 minutes is classed as problematic. However, these average latency numbers involves the child actually wanting to fall asleep and lying in their bed in the dark, and any of the children’s wonderfully inventive delaying tactics “One more story”, “I need the toilet”, “I need a drink”, “Mummy sing to me” are clearly “behavioural” and not really to do with a “medical” sleep problem.

Night waking

As part of our natural sleep cycle, we all wake at some stage in the night. Most of us are able to close our eyes and will quickly fall back to sleep again such that we don’t realise that we were ever awake or close to waking. Where night waking is problematic is where children are unable to settle themselves back to sleep and start playing the drums and waking the entire neighbourhood in the middle of the night. Typically these children then decide to fall asleep at around 7am, just when they need to go to school, and then they either miss school as their parents are unable to drag them there, or they doze off in the classroom and can’t learn effectively. You can imagine the impact of this on their parents.

Co-sleeping

OK I am as seduced by the lovely mental images of canoodling up with my young children for a snooze as the next parent. Many parents are seduced into this as children love it and it often helps them to fall asleep more quickly, but each time you get the inkling that this might not be such a bad idea, I would like you to imagine you sleeping with your 15 year old son or daughter. If you don’t do something to nip it in the bud while your children are young, they might not “grow out of it” and it will be a battle to get them out of your bed and are not used to falling asleep alone. I would suggest that you turf them out of sleeping in your bed by age 7 years otherwise it may get horribly entrenched. Of course, the early morning “I’m awake” cuddles in bed are still fine!

So what can we do to help our children to sleep?

My paediatric colleague Dr Jess Turnbull who is starting up the community Evelina Sleep Centre off-shoot in my work-place has the following advice for encouraging good sleep habits:

  • Physical exertion in the afternoon – encourage daily exercise in children in the day-time. This will wear them out and make them physically ready to sleep.
  • Consistent daily bedtime – as with all things behavioural, if there is an established routine and children know what is going to happen and that they cannot get out of it, then compliance is more forthcoming.
  • Last drink 1-1.5 hours before bed – this reduces the likelihood of children needing to get up to go to the toilet in the night, which may make it harder for them to fall back to sleep.
  • Avoid sugar/ caffeine – fairly obvious really.
  • Try and have a routine wind-down regime in the hour before bed time (calming activities such as reading, bath, calming music). The idea is to try and calm your child down so that they are in the right physical and mental frame of mind to sleep.
  • NO SCREENS (TV, phones, tablets) for at least an hour before bed. TV programmes, phones and tablets are all designed to capture interest, attention and brain activity. Ideally, you want to be winding down your child’s brain activity in the hour before bed so turning off screens is desirable. I know that many parents are tempted by having a TV in a child’s bedroom to keep them quiet and contained in the day, but it then requires discipline for children to stop watching it late into the night. Only be happy to provide a child with a TV in their room if they possess such discipline or you are happy for them not to sleep.
  • Having a transitional object (eg. a soft toy) to develop sleep confidence and a healthy sleep association. This can be particularly helpful for younger children.
  • Working towards your child falling asleep by themselves in their own bed. If a child is used to sleeping with you, then you should gradually withdraw yourself. For instance, first get the child accustomed to sleeping with you sitting next to them, then in a chair in the room, then outside the room in sight, then outside the room out of sight. It takes time, patience and grit to do this as some children will really dig their heels in, but if you view this as ultimately for their own good (which it is) then it is more possible to undertake.
  • Limit setting on ‘fussing’ after ‘lights out’. If you draw out the bedtime process with attending to the child’s fussing, then it defeats the purpose as it will get later and later and only teaches children that you will give them attention for their fussing which encourages them to continue to do it.
  • Reducing attention given after ‘lights out’ to prevent reinforcing messages of attention (e.g. avoid eye contact and conversation): good old pursed lips and silent treatment. There is a rule in my house that after the official bedtime, “Nice mummy” goes to bed and “Horrible mummy” her doppelganger comes in her stead. Nice mummy cannot be accountable for the actions of horrible mummy and so it is much better for children to just go to sleep.

But I had done all this and still, Lil Bro could not get to sleep. This was even more annoying and I was starting to put it down to “naughtiness”.

The next day, I was lucky enough to be chairing a talk on Smith Magenis Syndrome (a genetic disorder which was frequently associated inverted sleep cycle – i.e. day time sleepiness and night time waking) and my colleague Paul Gringras was the invited expert. Half-way through his talk, he spoke about the solution to keeping these children awake in the day was by using blue light to cut off melatonin secretion in the day. Melatonin is the natural hormone our pineal glands secrete to tell us it is night time and aids sleep. It’s pharmaceutical form can be bought over the counter in the USA as a treatment for jet-lag and is a commonly prescribed sleeping tablet.

Hang on a minute, Lil Bro had recently been given a fantastic blue Star Wars light sabre light that he had been insisting on turning on as a night light when he went to bed….this type of blue light is used to KEEP CHILDREN AWAKE….aargh. We had been inadvertently switching off our son’s natural melatonin secretion via Luke Skywalker’s weaponry.

I double checked Jess Turnbull’s list of advice and saw that I had overlooked: “Use a red coloured light if night light is needed (does not interfere with natural melatonin production)”. That evening, I told Lil Bro that an important sleep expert had told me that his special blue light was keeping him awake. Lil Bro likes science and reason and he felt good that there was a reason for his insomnia and that it was not just “bad behaviour”. It’s silly mummy’s fault for letting you have that light on (he likes not being to blame). Releasing him of anxiety about insomnia and allowing the release of melatonin by switching off the offending blue light sabre led to zzzzzz-bonk!

Resources:

 

References:

The info from this post came from: Turnbull & Farquhar 2016. Fifteen-minute consultation on problems in the healthy child: sleep. Arch Dis Child Educ Pract Ed 101: 175-180.

 

 

Public Library to Publishing

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Around this time 2 years ago I ventured into the public library. The library has always seemed to me a calm and comforting place where natural introverts like me can hide without need for social interaction. I have fond memories of public libraries from my childhood.

  • My parents did not have much money for books when I was young and so it became a Saturday ritual to take us to the local library. My sisters and I delighted in the weekly routine of 4 books in and 4 books out. The sitting with a pile of books on the library floor to make the book selection was as much fun as the devouring at bed time. Decisions were critical of course as it could never be guaranteed that a book cast away could ever be found again in the bowels of the public library system. I conjured up images of the child that never returned the book that I had set aside for next week. I remember tittering as my precocious sister stole into the forbidden adult library to feed on the minds of Austen, Bronte and yes, Mills & Boon.
  • As I grew older, the library routine became an independent journey. There was a Mobile Library that parked on the next road from my house. Come rain or shine, the humble little van would open it’s doors to a wonderful and shifting collection of books rammed onto wooden shelves that seemed to be hewn from the very carcass of the van. It’s purpose? To open my mind. Here I discovered childhood favourites from Roald Dahl and Enid Blyton to Paula Danziger, Judy Blume (who can forget Ralph?), Robert Cormier and S.E. Hinton. From books I spent a childhood learning and yearning to be British and the teenage years aspiring to be American. 2016 has made both youthful aspirations rather less enticing, but I think the core of what I mean still stands: books shape opinions, identities and lives.
  • As an adult, sadly the enjoyable public library routines of old fell away to being buried in book stacks of University Libraries. The “downstairs” of the Institute of Psychiatry (IOP) library was in my day a pleasure. Hidden away, accessed by spiral staircase is a room with more books than space where one had to churn a handle to move whole bookcases in order to squeeze between the shelves to retrieve the required tome. It’s fortunate that it was almost always devoid of people, because the one occasion where the bookcase started to move while I was trapped in between stacks brought back Star Wars style nightmares of being crushed by advancing walls. It always impressed me that amongst those books were the first clumsy descriptions of Down’s Syndrome, Schizophrenia and Autism. The pleasantly eerie bolt-hole had an atmosphere that’s hard to recreate. Sadly, it’s all gone now, and the IOP library – like most things – has “gone digital” and now resembles an Apple Store.

A return to the public library was heralded by having children of my own. Although not quite up to the organisation of weekly visits, the public library is a space that my children know and enjoy. Helped by lack of overdue fees on children’s books and Drop-Back boxes for books, sporadic and opportunistic visits to the library are possible. My children, like me before them enjoy the rummage and many of their favourite picture books were bent and battered copies of random and obscure books (for instance one about a girl called Tina and an alligator that trips on soap while doing the Tango and falls down the toilet) bought for 20p from the Library rejects sell-off bins. While the children explored and tried to hack into the library computers, I would wander to the parenting section.

During this particular library visit 2 years ago though, I wasn’t exploring the parenting shelves, I was asking the man behind the desk for the little red book – “The Writers and Artist’s Yearbook 2014“. The Writers and Artist’s Yearbook is an agency listing for budding writers and artists.

I had decided to take the plunge. I scoured the book for agencies interested in non-fiction and parenting. I took down the emails. I went home and I sent out my story.

I had been here 2 years earlier for the same reason. I had written the beginnings of a manuscript about my childhood and it’s influence on my parenting. I had pored through the agency listings and sent off my manuscript to 5 agencies. I was rejected by all of them, although one had nice things to say. It wasn’t easy to think about going through this process of rejection again, but since the first round of submission, I had started the blog and was warmed by the people that had responded to my writing. Friends and acquaintances would stop me and say “I liked your last blog” or “my wife reads your blog” which was a real encouragement. Also, as I had nothing better to do at the time (as high flying work-places dislike women with young children), there was nothing to lose. Sometimes it takes having no easy option available to force us to take a risk.

And so it came that a lovely young mother connected with my story and agreed to become my agent, followed a year later by another lovely mother offering to be my publisher.

And that’s how I got to meet proper writers: Russell Brand, Joe Wicks, Jack Monroe, Leah Garwood-Gowers, Daisy Kristiansen, Laura James and Eleanor Morgan and pitch with them to media and retailers our books that will be released by Bluebird Books (Pan Macmillan) in 2017.

For those that harbour manuscripts (I know at least one-friend) – please send them out – it really does happen! And if you can, pop in to your local library. Without us they have been closing up and down the country and with their closure the door and mind-opening opportunities for many children.

VaNITy Case

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Now that the children are a little older, I am finding that I finally have time to look in the mirror. This is a very depressing past-time as over the last 9 years, I appear to have aged 90 years. Bags under the eyes, lines traversing the face, spare tyre around the tummy and plenty of black hair turned grey! Some of these aspects I find acceptable (crows feet while not exactly welcome, are a sign of a life spent smiling) or readily remedied (thanks L’Oreal) – and I may finally get to claw back some benefit from that under-utilised gym membership. What I found very frightening was to see the piles of dyed black hair clogging up the plug hole of my bath every time I washed my hair. Hair-loss – extremely frightening. There was definitely a bit at my hairline which looked thinner than previously and I started to find the jokes that I had made about my husband’s retreating hairline less amusing. (When he had denied any hair loss, I had told him that he should tattoo his hairline and then we would have physical evidence of whether or not he was receding – funny I thought at the time, not so funny now that I am suffering the same fate!).

So when I next trotted off to the hair salon to get a hair cut; I wow-ed at the massive poster in the window which promised “Thicker, fuller hair could be yours” with a whole new product range targeted at thinning hair. Even for evidence-based scientists, rationality goes out the window when faced with fear and the potential of hope, however unlikely. The hairdresser was kind enough to doubt my need for the product but was only too happy to sell me the entire range given my disposition. He warned me “It works on your scalp so if you feel it tingling on your scalp, you’ll know it’s working.”

Over the next two weeks, I diligently used the entire product range, and indeed, soon after I felt a tingling on my scalp. “Ooh, I can really feel it working!” I thought to myself and liberally applied more product. The tingling got stronger. I inspected my hair daily. “Hmm” I thought to myself, my hair is looking fuller. More product slapping. Hang about, this product is starting to itch more than tingle now. That must be a sign of all the new hairs that are sprouting out of my scalp, because I know that when new hairs grow they can sometimes itch. More product. What fabulous hair I now have, well worth the itch because as everyone knows: “you must suffer for beauty”.

A week later, I was clearing out the detritus of school letters and notes that had formed at the bottom of Big Sis’s school bag. Oops, I have not yet paid the school dinner money. Thank goodness, I am in time to give permission to a school trip.

Then, I saw it and the penny dropped.

“There has been an outbreak of nits in your child’s class”.

OMG.

It was quite something other than new-age, hair-growing potion that had been working on my scalp and my vain mis-belief had led me to tolerate it blindly!

For the next 3 weeks instead of gentle, herbal, hair-regeneration and scalp renewal product, I was in the chemist hoarding chemical agents, the more toxic the better. None of the homeopathic agents for me, I was for all-out chemical warfare and instead of wishing for hair growth, I was happily pulling out my own hair with a fine toothed nit comb shouting “Out damn nits!”

Vanity really doesn’t pay.

Half term without the other half

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This half term I am braving the entire week with the kids without the other half.

Despite working 8am-8pm most days, Banker declared he also has to work the half term. I have recently come to the conclusion that the term “working class” to mean a low-waged  worker (previously miner or factory worker, but more latterly I’m presuming a tele-marketer or warehouse picker) is now a total misnomer because, let’s face it, only a very few landed gentry or Russians these days don’t work, and the majority of wealthy (rather than Über-rich) people are putting the hours in. Why don’t we update the nomenclature and call a spade a spade? The “Well-renumerated” class and the “Poorly-Renumerated” class; or the overpaid and the exploited classes?

Previously I have taken the kids for 2 days to Brighton by myself and last Summer I took the kids around New York by day by myself but this is the first full 5 days/ 4 nights. I know this is completely wimpy because single parents, widows and widowers do this sort of thing all the time, but hey, I AM A WIMP.

Softening the blow, I decided to check into a luxury family Hotel: The Ickworth Hotel, near Bury St Edmunds. This was a second choice: luxury hotels these days being cheaper (£290 per night including breakfast and adult’s dinner) than Centre Parcs (£390 a night self-catering) which I found surprising. The economy I think is gained by ditching the husband, as in a hotel a family of three takes up only a double room with extra camp bed wheeled in, while Centre Parcs caters strictly to your average family of 4 so you in effect pay for an empty bed if going it alone.

Ickworth was a known entity as my family have stayed here before, albeit the last time Big Sis was in nappies, Lil Bro was on the breast and I was on the Tena Ladies. Then it was all – “Wow, this hotel room has a nappy bin and access to a microwave to heat up Ella’s kitchen pouches” and “Thank God, the staff appear unconcerned that my kid is head butting the antique furniture with a bucket on her head”. So how does this hotel that markets itself to families, particularly of young children fare for a 7 year old, 9 year old and 40-something year old?

Rooms

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We had a small family room: a double bed and an extra camp bed rolled in. Not spacious, but perfectly adequate as we were certainly going to spend most of the day outside anyway. Décor is all old furniture upcycled with modern fabrics: so appropriately country house but grand enough to give city kids a bit of a Wow factor. Not quite the on-trend Babington House, but that’s also reflected in the price tag so I am not complaining. No mini fridge which was a bummer because I had to stash the pork pies I’d bought for lunches (not included in the room tariff) in the sock drawer instead.

Service

The Reception staff are friendly to children and when I couldn’t get the DVD player to work, they sent a nice man around: “You need to plug the DVD player into the TV” – oops.

Food

Food can be taken in the Conservatory for families or in the Candlelit fine dining setting for those that choose to use the Baby Listening Service or on-site babysitters. There is also a High Tea available for toddlers, but we tried this last time we came and I can only describe it as hell. Imagine 10 sleep deprived families each trying desperately to feed babies and toddlers at the same time, with anxiety heightened by the fact that this is “THE relaxing, couple bonding holiday” and the baby-sitter and romantic candlelit dinner has been booked so the baby has to be well fed and asleep in 30 minutes flat come hell or high water. Yeah, that kind of vibe. Thankfully this time, I could go for the Conservatory option. The food is average to good, but the menu stayed unchanged all week so I ate pretty much everything on the menu. Portions are rather huge so the kids were able to share my rather generous nightly 3 course allowance.

Atmosphere

Prepare to be Bodened and mini-Bodened. Yes, this is Boden central. If blond kids, check collared shirts and bright cords are not your scene then forget about it. I have the resilience of a stubborn pig so feel not the social pressure, but in the week of people watching I saw only one Black British family venture nervously forth into the Conservatory in their trendy leisure wear and they never returned. Towards the end of the week, a couple of Asian families that had drunk from the Boden cool-aid trough appeared; as did my doppelganger:

Big Sis: Ooh look mum, there’s a lady like you. She’s Chinese but married to a white guy.

Blegh. I am now a cliché.

The ethos is strictly “conventional family” and I noted that I was the only lone parent there in a week. I imagined the other parents looking sadly over at our table for 3 wondering about the death or divorce that had befallen me. “And since our Papa died, we can’t afford Boden clothing any longer…”

Activities

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One of the attractions of the hotel was the availability of on-site facilities for kids. A literal stable full of bikes and bike helmets meant we didn’t need the pfaff of bringing all our kit up with us, and a navigable, traffic-free country park within which city kids wobbly on their wheels, could safely practice in was ideal for us. An on-site swimming pool heated to the temperature of “warm-bath” is also within flip-flopping distance. Not quite the full on tidal pool and water slides of Centre Parcs, but in the morning and at lunchtimes, it’s possible to get the whole pool to ourselves which at half term is a luxury. Tennis courts, trampolines, croquet and football are all available, as well as a bank of family board games to play in the perfectly crafted “homely lounges” available. Unfortunately, they are all packed in the late afternoons, but hey, it is half term. The kids and I hole up in our room to play scrabble. I make them promise not to cry if I win. Yes, I am that mean mother that won’t let her children win at Scrabble. Cards, chess, Monopoly,  sure – but there  is no messing about in Scrabble.

The basement hosts kids craft activities and a games room where my tech-deprived two slink off to from time to time to play Wii Bowling and Air Hockey. They befriend a kid who spends the day in his Boden pyjamas; such is the “home away from home” feel of the place. In the evenings there is a cinema, but there were no adults there so I felt a bit of a spare part wandering about my room while my kids watched the movie. Yes, when you finally get rid of the darn kids, you end up moping for them. If Banker were with me, we could’ve hit the bar, but as it was it was kind of lonesome. The rest of the week we opt for borrowing family-friendly DVDs (Harry Potter, Cool Runnings) from the hotel to cuddle up and watch in our room.

Day Outings:

On day 1, we ventured out for some “educational activity”. As a Chinese parent, going on holiday without at least one “educational outing” can induce stomach cramps and nausea, so it is best to get it out of the way first thing so that you can breathe a little easier the rest of the holiday. I choose West Stow Saxon Village. It’s basically a couple of mock-Saxon out buildings strewn with what I presume are volunteers dressed in mock Saxon garb pretending to be Saxons. There are some ladies moulding mud to make a Saxon oven, another lady crocheting some Saxon cloth and another whittling wood. There are a couple of teenage boys pretending to be Smithies banging away on bits of B&Q iron attempting to make an iron dragonfly. Lil Bro is fascinated by this and keeps returning to check on the progress of the dragonfly. After 3 hours they have basically twisted one piece of iron and hammered out 2 feet. At the last return they’ve shut up shop and are eating Tesco’s finest buttered raisin toast in Saxon garb. There’s also a child friendly museum where kids (and adults) can also dress in Saxon garb, don a Saxon helmet and look at remains of artefacts that were actually dug up at West Stow. Quite cool except that it brings on lectures from Big Sis regarding the Neolithic and Mesolithic periods and all about querning which they have apparently been learning about at school. Quite the Hermoine Granger our Bis Sis, fantastic yet also slightly wearing. When I had thought about an “educational outing” I had meant educational for them, not for me! I bundle them off to some archery activity just in time as Big Sis looking up at the clouds says “Ooh, look at the Stratus clouds Mummy – we’ve been learning about cloud formations at school…”

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On Day 4, I pack both kids off to Barrow Farm Stables (a 20 minute drive away) for a “Pony Experience” day. Sadly Lil Bro is the only boy (why can’t boys do ponies?) but they both seem to enjoy themselves, and this time, no moping about for me as I have booked myself in for treatments at the hotel’s spa. Yipee.

On our final day, we will visit Ickworth House, the National Trust Property next door to the hotel. Hotel guests get free entry and there are family friendly Halloween activities on, so that’s a good bonus. We’ll finish off on afternoon tea then head back to London.

The Children’s verdict

The kids have had a blast. They are requesting to come back again next half term. “The people here and the other children are all so nice”; and it turns out that the kid in Boden pyjamas had asked my kids the question that all adults wondered but never dared ask:

“Is your dad dead?”

Big Sis: No, he’s working in London.

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Is it just me that hides in the toilet at conferences…?

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Today, I have been at the British Mecca for Psychiatrists, the annual conference of the Royal College of Psychiatrists. We have taken over the ICC in Birmingham where the entrails of the Tory party conference are still being tidied away. I did have a double take moment of “Lord, I’m at the wrong conference” when I was greeted with the “A Country That Works For Everyone” signage which dwarfed our college’s diminutive logo. The juxtaposition being even greater because within the medical profession, the psychiatrists are probably the most left leaning, our life’s work being in the care of some of the most discriminated and disadvantaged in society who are not usually the Conservative party faithful.

I’m not really a “conference” person. Brown-nosing and networking brings me out in hives, but I have been around long enough to know just enough people to make small talk to. At shrink-fest this usually involves grumbling about:

  • Lack of in-patient beds
  • Being mistaken for a psychologist
  • Not being recognised as “proper doctors”
  • Lack of medical students wanting to train in our wonderful specialty

Mostly, I am robust enough to endure colleagues darting-off mid conversation to talk to someone else of greater importance. Occasionally, I bump into old supervisors and I have to admit to them that I’ve chucked in my research and pretend to be blissfully happy about this decision. Other times I catch sight of another female ex-researcher and we indulge in metaphorical hand-holding and sighs of “it’s so hard with children”.  If it gets too much, I hide out in the loos checking social media. People post me pictures of dead animals (anti-hunting friends – don’t ask).

It might sound awfully depressing, but I also learnt these amazing nuggets:

From the wonderful Dr Andrea Danese, an Italian contemporary who heads up the Stress Lab at the Institute of Psychiatry. He once gave me a good recipe for pesto and today, he taught me this:

  • If you get a nasty cut that gets infected, the skin gets red and “inflamed”. If we took a sample of your blood, we would find raised levels of proteins e.g. C-Reactive Proteins which are called inflammatory markers.
  • Stress can cause an inflammatory response, just like an infection in quality but milder. This is to prepare the body to fight stress, in the same way that your body prepares itself to fight an infection.
  • Children and adults with depression have raised inflammatory markers.
  • These markers are even more raised if there was evidence of early life stress such as childhood maltreatment.
  • Adults with raised baseline inflammatory markers are more likely to have recurrent and chronic depression which does not respond to traditional anti-depressant treatments.
  • Anti-inflammatory agents usually used as pain killers after surgery (COX-2 inhibitors) have been successful in treating depression, particularly in people with high baseline inflammatory markers.

I know, this sounds dull to you, but to shrinks this is like: Yay! Another drug (cheap too) – maybe they won’t confuse us with psychologists anymore?

I also learnt from Professor Ian Goodyear (Head of Child Psychiatry at Cambridge University) that in his longitudinal studies of depression he divides us parents into the following groups which form a measure of “suboptimal family environment”:

  • Optimal (that’s me of course)
  • Aberrant (well-meaning but missing in action or clueless)
  • Discordant (bickering and self-interested)
  • Hazardous (deliberately cruel and abusive)
  • Not surprisingly, the majority of children raised by “hazardous” parents end up with all kinds of mental health problems.

And from Professor Eric Taylor, the grand don of my field neuropsychiatry:

  • 20-70% of children with ADHD continue to have symptoms into adulthood.
  • 50% have another psychiatric diagnosis by age 27 years (mainly anti-social behaviour, drug misuse or depression).
  • Children with ADHD with no friends and unsupportive, hostile parents at age 7 years are more likely to develop conduct problems and antisocial behaviour.
  • If a child with ADHD lasts to age 17 years without engaging in anti-social behaviour, their parents can heave a large sigh of relief because they will very unlikely ever engage in this type of behaviour (they may still be susceptible to depression unfortunately).

The best part of conference?

The hotel to retire to overnight. Totally kid-free: gym, luxuriating bath, telly, bed and totally guilt-free and legitimate because “I’m working!”.

Roll on day 2!

Back to life…but not as I know it

Signposts

Whoop whoop!

Yes! The kids are finally back at school and the extracurricular circus is almost organised. For those sensible enough to avoid enrolling children into a hundred and one activities, I salute you – because really, the logistics are too much! Having been rather gung-ho on the extra-curricular clubs when Big Sis and Lil Bro were little, I am now paying the price. The plan had been to shove them into as many classes as possible during the 3 days that I work and grandma looks after them.  This was a vain attempt to stop said grandma allowing them to veg on her couch watching Power Rangers Dino Charge and feeding them chocolate and hand peeled grapes like mini Romans for 3 hours each day. Instead, they were taken to some life-skill enhancing activity: ballet/ street-dance/ swimming/ tennis/ football/ chess before 2 hours of grandma allowing them to veg on her couch watching Power Rangers Dino Charge and feeding them chocolate and hand peeled grapes like mini Romans. Don’t ask me how come my beloved mother who locked me in my room until I could recite my times-tables at the age of 5 years, and who I had been counting on to knock some discipline into my kids has transformed into dobby the house elf.

Anyhoo, the unforseen pig of it all is that as the kids get older, the darn things get better at their life-enhancing skills and progress to different classes which are now OUTSIDE my 3 working days and the kids are back watching Power Rangers Dino Charge and being fed chocolate and hand peeled grapes like mini Romans on my work days, while I am left slogging them to ballet/ street-dance/ swimming/ tennis/ football/ chess on days when I am in charge. Don’t even ask about the crazy timetabling because Big Sis’s swimming now clashes with Lil Bro’s street dance, and I have to fathom if logistically I can get from the piano teacher to the swimming pool in 10 minutes…(I’m thinking potentially possible if Big Sis plays piano in her swimming costume). Man it sucks.

The good news is that not only has daily life returned after the chaos of the holidays because the kids are back in their school routine again, but my blogging life has returned – (Yay!). I’m hoping that some of you may have missed me (yes – I am talking to you dear sister) and will pick back up where we left off for the fortnightly Friday blogs.

In explanation of my long absence, I am pleased to say that much fun was had the last 6 months indulging the fantastic and unreal opportunity to pen a parenting book. Bluebird, the life-style imprint behind the lovely Joe Wicks and his midget trees have backed and bought my story. Thank You! I am so looking forward to this crazy new journey which is a world away from cutting NHS waiting times.

They say that there is a book in all of us and many people harbour a dream of writing a book. Many of us have half written manuscripts in our dusty drawers or notebooks and hard drives of half-formed ideas.  For decades I was one of them. My aged computer still contains very early drafts of a parenting book that I had the audacity to pen before even having children. Needless to say, these naïve and sentimental ponderings were a pile of crap and if the me of today had encountered the me of then, I’d have spared no hesitation in giving myself a tight slap and saying: “Have you ever met a child you twat?” Although I don’t think that you need to be a parent to give advice on parenting, an ounce of realism helps.

And so it turns out that although having children was the nail in the coffin of my treadmill professional career, being chucked off the treadmill gave me time and opportunity to explore other areas of myself and take a chance on an old and buried dream. It was the beginning of this new journey. What has been a heartening realisation is that while my having children was seen by my traditional profession as a weakness, for my writing it has been my greatest strength. I can only encourage others that if ever you fail because of a “weakness”, just change the story and it may turn out that your “weakness” is your greatest strength.

And if you have a dusty notebook or neglected files on your hard drive, maybe it’s time to have another look…

See my book’s news (although that long title will change)

Star of the Day One-Up-Manship

Pip3

Your kid has been a fab goody-two-shoes at school – so what better reward than the “Star of the Day” prize of a germ-infested, grime-encrusted, soft toy to bring home? This cuddly is passed around from child to child on a daily basis, and if what my children do with it (kiss, cuddle, canoodle, throw about the place and sleep with) is indicative of what every child does with it, then I am pretty sure that if Pip the Panda were an adult human, he’d be harbouring every venereal disease going. Not only are we supposed to harbour this bacterial contagion, but we are supposed to show it a good time and document the good times had to be shared with the rest of the class, and more importantly, the rest of the class’s parents in a book that gets handed around.

This has led to what I term “Star of the Day One-Up-Manship”. Pip has been to Disneyland Paris a few times, weekends away in the Cotswolds, holiday homes in Suffolk and has even met the “Housekeepers” of my children’s classmates. I love it as you can peer into the lives of others without being caught out as “nosy”, although of course other parents are acutely aware that their entries will be inspected and the entries have a social media gloss: the children are always smiling, they’ve always done something interesting and it’s all happy days. No one is writing: I went home. I watched TV. I ate junk food. I delayed getting into the bath until my mother screamed at me like a psycho.

In a mini-rebellious streak, I thought about taking Pip to the pub, plying him with alcohol and cigarettes and documenting his “Ted” like night out on the town, returning him to Reception smelling of lager and fag-ash. Sadly, I wimped out. So instead, I photo-shopped him into old travel snaps with Lil Bro in tow.

“After school, we climbed to Machu Picchu, deep water dived, explored the temples of Angkor Watt and visited my mother in China”

Lil Bro enjoyed the dressing up and we could spend the rest of the weekend watching TV and eating junk food instead of taking pictures of us eating super foods and doing healthy exercise in our very well-decorated home. The best thing was that the Reception kids who have no idea of Geography actually believed that this was an accurate depiction of life chez Lil Bro. Too cute.

Pip4

Pip1Pip2

 

The Return of the Mum

Love

Shrink Grows Kids is 2 years old! And more exciting things are happening: I have been offered two book deals and am about to sign up with the lovely people at Pan Macmillan for my first ever book. So thank you to everyone who has read and supported my little site. Your reads gave me the confidence to continue and it has led me to things beyond my imagination.

Those who followed my journey from the start may have realised by the tone of some of my blog posts that I started this blog as a child psychiatrist that had been somewhat cast aside by her profession for her decision to work a maximum of 3-days a week such that she could be there for her children. Working so little is highly frowned upon in a profession where apparently working till 10pm and on Saturdays is deemed a standard working week (thanks Mr Hunt). In the battle of children vs career, for me children had to win out.

It’s a tough decision faced by many driven parents and I respect the individual choices made by others even if they differ from mine. For me, I am lucky enough to be married to a banker who pays the mortgage and financially as my post-tax income would have been equivalent to quality childcare, money was negligible in the decision making. Unluckily, being married to a banker means that for much of the time parenting responsibility falls to me as Banker is often out of the house before 06:30am and not back again until 8pm, if he is even in the country. Thus I squarely felt the responsibility of how our children turned out was down to me. As a child psychiatrist who spends days and years hearing and helping children and families that have struggled, it seemed implausible not to at least attempt to practice what I believe and preach: spend time with children.

For quite some years I took positions that allowed me to work a 3-day week by virtue of my being over-qualified and under-paid and saw friends and colleagues speed by in the race to the top. It was not without its frustrations, anger, tears, self-hatred and despair. What was the least anticipated, yet most destructive was the loss of identity. I would never have seen myself as one for airs and graces and felt that I took people on face-value, but it was amazing how naked I felt when stripped of a prestigious job title. Signing on reluctantly for gym membership post-baby fat one time I felt wounded to see that the lady had listened to my description of my work circumstances and had written: Occupation: House-wife/ Doctor.

I had never identified myself as a house-wife. A mother yes, but not a house-wife. I don’t and doubt I ever will darn my husband’s socks (although once my mother-in-law did offer to teach me).

It was with this inkling that I wanted something more that I tentatively set up my blog. Slowly by slowly, with your help, a sense of confidence and purpose grew that even if the system would not support me, I could use my skills to support myself. I started speaking to friends  about work outside of the NHS which although I loved, had rejected me for my lack of ambition/ work-ethic/ dedication because of my insistence on limited hours. We set up a little private practice which has been doing great. This led to more confidence in my ability, to connections and friendships which have led to more and more opportunities, which have eventually culminated into a return to a prestigious NHS position on MY TERMS – 3 days a week. Alongside, the material from my blog has continued to grow, albeit slowly of late, and I am still pinching myself that a publisher is willing to support me in growing it into a book. Never in my wildest dreams did I think that I could or would become a writer.

My horoscope predicted that 2016 could be one of the best years of my life (so be happy all Pisceans) and I am really looking forward to the year. My message to other parents that chose children over career is to say “Believe in yourself”, give it time, you never know where it might lead you and soon you’ll be back on top.

THANKS FOR SUPPORTING MY BLOG.

WATCH THIS SPACE FOR NEWS OF MY BOOK!

Here are some posts from rock bottom that might help:

Dear Me

Advice to My Former Self – Desperate Working Mother of Two Young Children

Did You Get Maternal Adjustment Disorder?
 

 

Tomorrow is a new day with no mistakes…

Anne

It’s Christmas morning and the tree is adorned with coloured lights and decorations. The breakfast table is set with Panettone and tea, and oysters sit at the sink in preparation for lunch. We are back in the French countryside with my in-laws, settling into what is likely to be the last Christmas in rural France, as my in-laws are soon to be down-sizing and giving up the idyllic life in their rustic farmhouse of over 20 years.

But something is rather off.

This year, Father Christmas has not arrived and there is only one present each for the children beneath the tree from the grandparents. Lil Bro is wearing Granny’s old t-shirt unadorned with trousers or the like, above which he is wearing great granny’s cardigan such that the sleeves overwhelm his arms in the manner of a vampire bat. The look is evermore preposterous as he is intent on running around flapping his sleeves so that they whip his back in the manner of self-flagellation. His bare skinny legs protrude beneath, drawing attention due to their perpetual motion. Big Sis sits curled-up cat-like in a nightie of unknown provenance that comes down to her ankles, on the lap of her father who is sporting a pair of flowery shorts from his adolescence.

This year, I have felt moved by the plight of Syrian refugees, sick children, evils of capitalist excess and humans as the cause of climate change that we have embarked on a sinless Christmas where we reject commercialism and think about the true meaning of Christmas. As such, there will be no presents, no decadent wrapping paper and Santa Claus will not call. We have chosen to think of those less fortunate than ourselves and donate all the children’s presents to charity.

Don’t be daft! I’m a shrink not a saint!

Rather, let me fill you in on the ridiculous antics of the night before. Having spent days meticulously ordering gifts from Amazon, and further more days sitting at home to try and receive said ordered gifts from Amazon, and further days puzzle-piecing boxes and boxes of gifts into big black suitcases, and coaxing Big Sis to help reassure Lil Bro that Santa is very clever and will find us in France (Big Sis has figured out about Santa – but that’s another story); we were finally set and ready to go.

Bundled off we went with 3 large laden cases full of paraphernalia, eyes bright in anticipation for a calm and restful Christmas and a short sojourn of skiing thereafter. Because of the mass of our present haul and the multitude of “essential skiing gear”, I whittled down my own belongings to a small wheelie case, pathetic amongst the other large ones. Little had we anticipated the disaster encountered at London Bridge when 2 trains to Gatwick were cancelled. Never fear, Uber is here. A cab was called and disaster was averted by a knight in shining Mercedes that pulled up some 8 minutes later.

The children and I crammed into the back seat and promptly fell asleep after the excitement of the morning’s rush to head off, but some 40 minutes later I was rudely awakened by Banker’s woeful tone “I think we are going to miss our flight”. Then it was tender hooks for the remainder of the journey. The Uber-man remained optimistic to the last, but my pessimistic nature understood that we were doomed. Never-the-less, we took the chance that given we had checked in on-line that there was a slither of a chance.

The dash to the luggage drop off point was in vain, even after having nearly knocked several people sideways with the big, heavy case.

The baggage drop-off point was closed.

The gate to boarding would close in minutes.

The next flight out from Gatwick would be boxing-day.

Banker and I looked at each other. In a split second we both understood that Christmas was about family and not presents. We dumped the big bags at left luggage, not even stopping to give details of who we were or where we lived. The attendant seemed to understand, put a barcode in our hands with a telephone number hastily scribbled on the back, shouting to us as we fled “Run! Don’t worry about your bags! Just call!”

Banker, with marathon and triathalon training was sent as the forward party, without a look back he leapt over obstacles and weaved his way to Gate 20. I followed as fast as I could encumbered by my backpack and case, the only case deemed small enough for hand luggage, shouting encouragement to two children who trailed behind. They made a good start, having sensed the dire nature of the situation. Lil Bro, who had killed the Reception sprint at his last sport’s day made good ground. Big Sis who had participated enthusiastically in the Borough Cross Country continued apace. But believe me when I say that Gate 20 was a LONG way from the security gates. At Gate 4, when the computer screens heralded that boarding at Gate 20 was CLOSED, I wondered if my legs could make it. Behind me, I heard crying as Lil Bro succumbed to the enormity of the task. I went back and grasped his hand. Banker was nowhere to be seen.

I pulled Lil Bro by the hand propelling him forward. “Lil Bro”, I said, “We are tired, but now we can press our “Booster Pack” buttons and set off our reserve fuel. The Gate is closed, we have to run or there is no chance”. We plundered on, shouting and waving to poor Big Sis each time we turned a corner so she did not get lost as she was ten metres behind.

Eventually, we got to Gate 20 where Banker had made them hold the gate open. Sweating like a pig and with two crying children in tow, bereft of worldly possessions, we boarded the flight. On the plane, Big Sis and I started to muse to Lil Bro about the possibility that Santa may not be so smart after all, and had he left Santa a note to tell him we would be in France? Because if he hadn’t then Santa may deliver the presents to London and there would be no presents until we were back in London, but not to worry as they would be waiting safely there….

For all that people say about the cynicism and materialism of children and their obsession with more and more toys and presents at Christmas, and the frenzy-like states that parents get into to prepare for a Magical Nigella-esque Christmas “for the children”, I can attest that the half-naked children swathed in foraged clothes made not one complaint and had a perfectly splendid Christmas in the company of their grandparents. For all our doubts, even 21st century children can understand that Christmas is about family, not presents.

As for me, I was thankful that I had packed the 5 disc-collectors’ edition of Anne of Green Gables (a nostalgic Christmas present to myself) into my own tiny case. At least I alone am fully clothed and will be having a merry Christmas introducing Big Sis to Gilbert Blythe…

Tomorrow we hit Decathalon’s ski section with gusto!

I hope you had a Merry Christmas without our mistakes!

 

 

 

This Boy Can

This boy can

I love Sport England’s “This Girl Can” campaign to get girls into sport with glossy ads showing ordinary girls and women of all shapes, sizes and colours enjoying sport. Set to high octane music it oozes adrenaline, power, energy and confidence. It’s about sport, but also ultimately about self-esteem. Its underlying message is that women should be confident about themselves and their bodies, which is a great message which is why the campaign has been so acclaimed. There have been a number of other positive Ad Campaigns empowering women to achieve, study maths and science, aim high, aspire and be ambitious. GREAT! Despite all that women have achieved in the last 100 years, I can attest that women still underestimate their ability in the workplace and this media encouragement is totally welcome.

However, it doesn’t work on its own.

How do I know this? Because I, and all girls that were fed through an ambitious, high expectation girls’ school in the nineties already heard this message and were already ambitious and aiming high. We flew the flag, but like the generations before us were cut down to size when we reached the higher echelons of our organisations, or the minute we fell pregnant. Many of us even felt bitter towards the encouragement that we received as young women because we were fed a dream that society could not yet deliver.

The bottom-line is that there is only so much women can change and society’s current solution of “encouraging women to change” (codified in encouraging women to become “more” confident/ ambitious/ this-that-and-the-other) in order to fit into pre-existing male oriented organisations and structures has not worked. Not only has it not worked, but it continues to perpetuate the myth that the reason that inequality has not yet been achieved is because women have not put in enough effort into changing “they do not put themselves forward”, “they shy away from leadership positions”, “they choose to opt out”. The implication is still “Women are not good enough”.

This perspective turns a blind eye to the fact that it is also institutions and their cultures that need changing. Women are being put off by bullying and macho cultures exemplified but not limited to the goings-on in British politics (men are driven to suicide by it, so why would women want to engage?).

And, if society wishes there to be a next generation, SOMEONE needs to look after the children. For many of us, we believe this strongly and fundamentally should be parents. If we continue to one-sidedly empower girls and women to take on rewarding and powerful careers, what is society’s solution to “parenting” and “family-life”?

What is the solution?

It may not seem attractive at first (but isn’t it the job of slick Madmen to make it so?), but I believe that for every “This Girl Can” ad that goes out; there should also be a “This Boy Can” ad. Footage of boys crying, talking about their emotions, helping another child, reading, drawing, dancing, dressing up as a Princess. Footage of men sticking on plasters, listening to the ideas of their female colleagues, talking to their daughters, nursing their elderly parents, helping children with their homework, picking up children from school, doing the laundry, cleaning the house, cooking the family dinner. These latter activities are the really important things that keep Britain going. The Engine of Britain is not just the boardroom, but the living room, dining room and kitchens across the country. Without the domestic engines, no one could get to work. As long as these activities, pivotal to family life, are undervalued and represented as “female” or lower order tasks, there can be no escape for women from the home and no “respect” for women overall.

Many boys and men already do these things and they need to know that their efforts are appreciated and the ones that are not doing these things need to be empowered and enabled to do so, else any women’s empowerment program will be futile. As long as we continue to view ambition, aspiration, hard-work, determination and ruthlessness as the only virtues worth rewarding and publicising, we are devaluing and undermining the equally valuable virtues of compassion, loyalty, understanding and sensitivity. As such we marginalise the fantastic people who possess these traits and create future generations with warped and unbalanced ideals. Much as I applaud campaigns to improve body confidence, body image problems in women will continue to be problematic as long as there are men who objectify women. While empowering girls is good, we must also focus on educating boys, and I feel that this part is lacking.

Whilst many may feel that traits are gender specific (typically masculine: ambition, determination etc.; and feminine: compassion, empathy etc.). I don’t believe this to be the case but that from a young age children are taught to emphasize these traits within themselves and suppress other traits to conform to gender expectations. While great Ad Campaigns like “This Girl Can” try to address this imbalance for girls, what we desperately need in concert is a “This Boy Can” campaign to empower boys to truly be themselves.

I really hope that someone steps up to the mantel and does it.