July 30, 2015


Taking Care of Your Child, 9th Edition: A Parent’s Illustrated Guide to Complete Medical Care. By Robert H. Pantell, M.D., James F. Fries, M.D., and Donald M. Vickery, M.D. Da Capo. $21.99.

10 Days to a Less Defiant Child, 2nd Edition: The Breakthrough Program for Overcoming Your Child’s Difficult Behavior. By Jeffrey Bernstein, Ph.D. Da Capo. $16.99.

     Lengthy, involved, complex, but laid out with clarity and filled with cross-references that make it easy to find what you need to know about any particular subject, Taking Care of Your Child is a true reference work. That is, it is not a book to be read but one to be referred to when you need the information it contains – much like a dictionary or encyclopedia (in book rather than online form, of course). Physicians and emeritus professors Robert Pantell and James Fries, working together and with contributions from the late Donald Vickery, have assembled a book that parents, whether first-time or experienced, can turn to in order to take better care of a child at home. The new, ninth edition of the book contains updated information on various treatments and scientific advances, but its underlying premise remains the same, as the authors tell parents at the outset: “Your care and judgment are still the most important ingredients for fostering a lifetime of health for your child.” With that in mind, the book’s focus is on various things that are likely to occur in the vast majority of children, not on rare events that may occur but probably will not. This is intended as a day-to-day guide for children who fit, very generally, within the normal bell-curve distribution: the 80% or so who do not have serious challenges of one sort or another.

     It is certainly possible to read Taking Care of Your Child sequentially, and that may be useful for first-time parents interested in details about pregnancy, birth and the early period of adjustment to being a family. But reading the book this way is both time-consuming and rather boring. That is because the book is not a narrative but a series of suggestions for handling specific child-rearing situations that may arise over time. For example, a discussion of “animal bites” takes up two pages of the book’s 550. Those pages discuss rabies risks and cross-reference separate pages on Lacerations, Puncture Wounds, and “Does My Child Need a Tetanus Shot?” There is also a cross-reference to “ways in which parents can teach their children to get along with dogs and avoid bites.” And one to “Pain and Fever Relievers.” Then there is a flow chart with three questions: “Is the face or hand involved?” “Is this a bite by a dog or cat whose rabies immunizations are current and who is currently being observed?” “Has this bite left a cut or puncture wound that might require a physician’s attention?” Answering “yes” or “no” to each question connects the chart-following reader either to the next question or to something specific to do immediately. And all of this is packed into a two-page section. That gives some idea of the scope of Taking Care of Your Child. The book does have room for non-clinical matters, and these can relieve the somewhat droning and rather overly careful nature of the text, as in, “Teething is important and necessary and can be done on almost any hard rubber object. Certain pacifiers, such as the Nuk pacifier, can be used in teething infants and may have the advantage of ensuring proper tongue thrust for proper jaw development.” In contrast to prose like this are, for example, comments by parents on their experiences with their own children – a welcome dose of “someone like me” to go with the “someone with extensive knowledge” writing by highly experienced medical professionals. Taking Care of Your Child has sections on non-traditional and alternative approaches to children’s health, but in the main it offers a solid, scientifically backed set of medically sound recommendations, and one laced with some genuine cleverness – such as a diagram of an arm splint made from magazines and cardboard. There is plenty of reassurance to be found here (“The only children who never have diaper rash are those who never wear diapers”), but there are also plenty of warnings about times to seek medical care immediately. Taking Care of Your Child is balanced, thoughtful, accurate, and immensely useful even for experienced parents. The tradeoff is that it is not particularly readable – but that is the curse of many a top-notch reference book.

     Jeffrey Bernstein’s 10 Days to a Less Defiant Child, on the other hand, clearly is intended to be read as a narrative, even though it has “reference” elements as well. The book really is arranged as a set of recommendations for 10 days, and Bernstein writes, “Whether or not you actually read this book in ten days, I recommend that you go through each of the ten days consecutively.” This second edition includes some new approaches to working with a defiant child – and with one’s own anger – and also incorporates diagnostic criteria for what is now called “oppositional defiant disorder.” And there are some significant changes in emphasis, notably involving a greater focus on the necessity of parents employing a “calm, firm, and noncontrolling approach” to their children’s defiant behavior. The foundational element of Bernstein’s approach is understanding and acceptance, with parents expected to bear the full burden of learning about a child’s behavior and making changes in their own words and actions to defuse difficult situations. This is unfair – parents have more than enough to deal with already – but clearly necessary, since, in Bernstein’s formulation, the parent has the problem with the defiant child; the child does not have a problem with his or her behavior (although in fact it may be evidence of underlying troubles or traumas). The parent wants change; therefore, the parent must change. This is a necessary mindset for anyone hoping to benefit from this book.

     Bernstein’s reasonableness can actually become irritating after a while: “A healthy child may be rambunctious, noisy, emotionally expressive, and have a short attention span. All of these ‘problems’ are not problems at all, but normal qualities of a normal child. …Your child has very little life experience, and he will inevitably make mistakes. …Yes, I know that being called nasty names by your own child and not dwelling on how this hurts may seem like a tall order, to say the least. This is where switching your mind-set from parent to coach can give you some emotional objectivity…” And there you have one of the kernels of Bernstein’s book: suppress or repress your own emotions by altering your mental attitude, changing from regarding yourself as a parent to thinking of yourself as a coach. Sports lovers may find this easier than will non-sports fans, but it is doubtful that any parent living 24 hours a day with a defiant child will find the prescription easy to take. The difficulty in Bernstein’s book is that although he says he knows how painful defiant behavior can be – and mentions enduring it with his own children – he recommends approaches as if what he is urging is not particularly difficult. That is, he offers a series of eminently sensible concepts and implementations, involving school as well as home life, as if their reasonableness makes it easy for a caring parent (or “coach”) to implement them. But this is very far from the case in real life, when simply getting through the day and dealing with one’s partner, other children (his, hers or both of theirs), other family issues, financial matters, and all the rest of the stressors of modern life can leave a parent with precious little time to take a deep breath, much less to reconsider his or her entire relationship with a defiant child. Yet unceasingly calm, cool, rational handling is what Bernstein recommends throughout 10 Days to a Less Defiant Child. To avoid power struggles, for instance, he says to “be courteous when you make requests,” “think ‘compromise,’” and “work on your own confidence and self-esteem.” Again and again, he writes recommendations such as, “Using these words repetitively (like a broken record), in a calm, firm, and noncontrolling manner will serve to de-escalate the situation.” Bernstein is right about this and, indeed, about a great deal of what causes defiant behavior and what can be done to change it, at least to some extent – his book’s title intelligently promises a less defiant child in 10 days, not one cured of the defiance habit. Despite all the intelligence and knowledge here, though, parents will find this a (+++) book – its positives being its underlying content and the thoughtfulness of its author (a licensed psychologist specializing in child and family therapy); its negatives being a lack of understanding of how difficult its ideas are to implement, and a failure to have (or at least to express) sufficient empathy for parents whose defiant-child issues are likely only one element of lives that already feel stressed, pressured, time-constrained and out of control on many levels and in many ways.

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