Three basics of parenting autistic kids

 When Marko was diagnosed with autism, I spent a lot of time stressing out. I wanted to know what this meant for my parenting. Where was the book that would tell me how to raise him? Where was the expert that was going to come and tell me what to do?

What I didn't realize right away was that I already had a leg up on any expert or book, because I had been raising him already for seven years. At this point, I've been raising an autistic kid for almost 13 years, and another one for six, and it's safe to say that I kinda know what I'm doing.

Especially as nobody else knows any better. Books exist, but some of them are dead wrong, and others simply can't tell you everything you need to know about your kid because the variation in autistic children is vast. I would argue it's much greater than the difference between a neurotypical kid and an autistic kid. I did read lots of books on autism, some of which seemed to be describing something very different than my kid, and some which had some helpful tips. Memoirs by autistic people actually helped the most, because what I really wanted to know was what was going through my child's head. When you know that, you can figure out what to do about it much more easily.

I could probably write a series of posts about this (and I might) but for today I just want to say: it's not complicated. It's just parenting. You have the same goals as other parents have, and while some of the tactics in standard parenting books will not work, plenty will. And that depends more on your kid than on whether they're autistic or not. Sensitive kids do not take well to yelling. Spirited kids hate to be told what to do. Some kids love when you joke around (Jackie does) and some will get more upset when you're silly (like Marko).

One of my main worries at the time was, do I try to change his autistic behaviors, or do I treat them as hard limits beyond which he can't grow? Should I be frantically trying to catch him up to his peers, or shrugging and watching them sail by?

In the end, it wasn't a helpful question. The real question is, which skills does an autistic child need and which behaviors are harmful? You should help them develop the skills they will need in life and guide them away from behaviors that harm themselves and others. Exactly like you do with other kids. But you need to have a lot of inner strength to stop yourself from comparing to peers, separating out the autistic side of your kid from the rest of the kid (you can't. your kid is your kid), or letting other people tell you to panic more. The person who tries to make you panic more is almost never a person giving you helpful advice. Either they're panicky themselves about autism, or they're trying to sell you something, but either way they clearly aren't here to help you.

Here are the three most vital skills I can think of for autistic kids. Though I am sure this is influenced by the specific ones I have; yours may be different. 

1. Regulate their emotions

2. Detect and regulate their sensory needs

3. Communicate needs to others

These are skills everyone needs, and autistic children may struggle with them more than others. There are many other skills autistic children struggle with: speech, fine motor skills, stylish dressing, detecting sarcasm, etc. But many of these are kind of optional, when it comes down to it, or they will naturally be getting some help with them at school. If you have an autistic child, you need to let go of the idea of your child being cool in school. They may eventually develop their own brand of coolness, but it's not a thing you can make happen. If they struggle with speech or writing or numbers, go ahead and nab all the therapy that seems useful, but be aware that some autistic kids won't catch up to their peers on these. You just can't know.

But these three are going to be vital, and the bulk of teaching them is going to rest on you, the parent, because you are there in more situations, when the need for them arises.

Emotional regulation

Not every autistic child struggles with this, but it seems like most do. I have seen arguments that autistic children only melt down a lot because they're treated so much worse, but I don't think it's just that. I have a sample of two autistic kids and two neurotypical kids, and the autistic ones just freak out more about the same size problem. Apparently the emotion parts of the brain are straight-up bigger in autistic kids.

At the same time, I'm not going to just roll with a house full of unhappy screaming. Let alone the physical aggression and property damage. I want my kids to be able to meet their upset feelings and work their way through them. At the same time, I don't want them to become repressed or self-hating.

I think a lot of emotional regulation problems stem from not being able to detect and name emotions, so that's step one. "I am upset, this is what upset feels like." This lesson alone took us years. And then "I can pause between becoming angry and acting on it." And last, "I have strategies to calm myself down."

This is all a work in progress. As kids are growing, you're not getting to step three on every meltdown. My main efforts lately are stopping them from hurting anyone, eventually de-escalating, and bringing the child to a point of being able to reason again. This looks like taking the angry child to another room, sometimes distracting with a conversation about a topic they like or giving them time to read or play a game, and then talking through the issue. How did you feel when that happened? Do you think it helped to scream at him? What could we do instead? Let's go back downstairs and ask him if he would like to play the game later.

To that end, I also bargain with my kids a lot. I want them to know that no is not a hard wall they have to crash into and then melt down, but only a roadblock on one specific avenue. What if they could still get something they want? So, no ice cream today, but maybe we could put an ice cream date on the calendar. Or we could go home and have the ice cream in our freezer. Whatever. 

And I never, ever set boundaries on the kids just for the heck of it. If there's no reason I can explain, well then I guess you can take a bath with your swimsuit on. You can go to school with your shirt on inside out. I'm going to encourage the whole underpants thing but that's not a hill I'm going to die on. With an autistic kid there are so many hills. You can't die on them all.

Sensory regulation

Everyone has a zone of sensory stimulation where they're happy. Maybe you're bored if you don't leave the house every day and you enjoy noisy parties, but after two hours of loud music you want to go home. Well, autistic people have a much narrower band of sensory comfort than other people. This may mean being over sensitive to some things, like textures or tastes or noise. But it also sometimes means they get twitchy and restless if they don't get to jump up and down, swing on things, or crash into the walls. So all the time you're working on giving your children the sensory things they need and protecting them from the ones they can't stand.

When your child is small, this is mostly your job. Your child can't communicate why that shirt is a bad shirt, but eventually you figure out it's tight on the armpits and go looking for shirts that aren't. You may learn how to bake veggies into muffins to avoid unpleasant textures, or give your kid hot sauce so there's a nice strong taste and they eat more food. It's a whole trial-and-error process. There's a growing market of items like ear defenders, seamless clothing, sensory swings, and compression garments to help autistic kids get into the zone where they're happy. There will be way fewer meltdowns this way, the child will be much more free to learn and relax and make friends and eat food when they are comfortable.

But while you're working on this, a lot of society is on the opposite track. They think sensory needs are a thing we fill for small children and have to train out of as they get older. Do they really need the headphones still? If they don't actively complain, we should take them away! And all that hand flapping or chewing on things is getting annoying, let's train them to stop.

The problem is that this strategy does not actually expand a child's zone of sensory comfort. It only gets them used to spending most of their time outside of it. They are under more stress, learn less, and are less happy. They may eat less and lose weight, but since they're a teenager now it's called an eating disorder instead of a sensory issue. They often melt down the second school is over.

It burns my cookies. Instead of transitioning to less sensory adaptation as children get older, we need to transition to children regulating their own sensory needs. They need to learn how comfort feels in their body and what tools they have to get there. I am 36 years old and I'm still working on "am I feeling listless because I am overwhelmed, or because I am bored?" If that's a struggle for me, it's obviously a struggle for a 12-year-old too. But it's so important to teach this, because at some point they'll be an adult and will need to keep themselves in their own sweet spot. And they may have to advocate for themselves about it. So at this age, we should be encouraging kids to understand their needs and ask for what they need. First from us, then from teachers and other adults. A child who can ask the teacher, "Can I please sit in the front, it is too loud in the back," is a child who will eventually grow up to say, "Can I work from home? I'm much more productive there."

Communicating Needs

This follows off the last one. Unfortunately autistic kids can sometimes be their own worst advocates. Some, of course, don't speak. Others can be amazingly articulate so teachers don't realize they don't know how to ask to use the bathroom.

I hardly know what advice to give, because communication difficulties vary so much and I'm only doing middling well at teaching this. Marko can ask to use the bathroom now, but he's constantly missing assignments in class and is terrified to ask the teacher for permission to turn them in late. A work in progress. And Jackie, for reasons I can't hope to understand, sometimes refuses to say "I would like some strawberry-kiwi juice, please," but will trace the letters SKJ on my stomach and expect the juice to arrive.

I think it's vital to accept every attempt at communication and encourage it. The last thing we want to teach is that efforts to communicate aren't worth it. We don't always know what is preventing a child from communicating in the way we might prefer. So refusing to comply until they communicate the way we want can result in the child getting frustrated and giving up. It is okay to become something of a telepath when it comes to our children's needs, detecting that "zzz" and a vague gesture toward the top cupboard means "raisins" or "I'm just going to change my clothes, no reason" means "I have had an accident and feel embarrassed, please play along." What we are teaching is that attempting to communicate is good and gets you things you want. Demanding "please" or clear enunciation often trips the stubbornness switch and they'll just climb on the counter and try to get their own dang chips.

When Marko was about four to seven years old, he refused to talk to any adults outside the family. He had a really pronounced stammer at the time, but even when it was important, he wouldn't even try. I finally found out--after years of this!--that he had noticed that adults in the family understood him when he spoke but adults outside the family often didn't, or didn't have the patience to let him finish his sentence. So he figured, why bother. It was considered "selective mutism" but what I call it is very sensibly saving his breath on people who might not listen. Once he went to school, he quickly overcame it because the adults at school asked him questions and waited and waited and when he finally did try answering, they listened patiently.

So always listen, even if the communication is a sign, gesture, tugging at you, sidelong vague passive-aggressive comments, whatever. And then after you've listened, you can suggest other ways. "You know, you can say 'strawberry kiwi juice' in words, I would have understood that one a lot faster." "Can you hand me your card next time instead of dragging on my body? I like that more." "Once upon a time, there was a little girl who peed her pants, and she decided to tell her mom, 'I had an accident, can you find me some fresh pants?' And her mom was not mad at all! The mom said, 'Thanks for telling me,' and got her some new pants." (This last is a real story that actually, to my shock, worked.)

When it comes to hard conversations, like talking to a teacher, our kids will need our coaching. I've sat by Marko and helped him draft emails to his teacher. I've sent him to go and talk to the counselor while also shooting off an email to the counselor saying, "I have sent Marko to you, please talk to him if he doesn't approach you." We don't expect our kids to be able to do things the first time without us holding their hands.

* * *

This list is obviously not exhaustive. There are a heck of a lot of other important things to teach autistic kids. But these are my main focus right now. I know that my kids will be on the way to building their own successful lives if they master these skills. None of these skills have to do with being less autistic, and all of them are about achieving their own happiness.

In another post, I hope to write a list of general tips about managing autistic kids. There are so many things I've learned along the way that baffled me at first. Parenting autistic kids is not mainly a list of hacks (which is why I decided to leave the other one in drafts and publish this one first) but I'm pretty sure we all need more hacks.

Two views on parenting

 I noticed, rather early in my parenting career, two very different attitudes toward parenting. One, which was mine, was that it is a job. I do it for the sake of my children. It is hard. I cheer on their milestones. The older they get, the closer I am to being done.

The other is that it is an experience to treasure. You are supposed to love every minute. You keep a baby book and tons of keepsakes. You are sad when they grow older, because then you're closer to this magical time being over.

At the time I kind of despised the latter view. I felt it instrumentalized children, made them a fun consumer item rather than a sacred trust. Isn't it our job to help them grow up, not enjoy ourselves? Won't this lead to people pushing their children backwards because they dread them growing up?

But I was watching Jackie ride her bike the other day, and I thought, you know what? This moment won't last. I need to treasure it. Even though I forgot to get a picture of it. Even though I never kept a baby book and lost the kids' ultrasound pictures and don't, honestly, miss the baby stage. There is something to be said for simply delighting in your kids. Because kids deserve to be delighted in. They need to know that being with them makes you happy. That they're not just a chore for you.

I feel that this was missing in the definition I learned of love from various Catholic sources. Love, they reminded us sternly, is not good feelings, it is desiring the good for the other. To which I say, sure, it isn't just good feelings, but when people crave love, they don't simply crave being cared about. We want to be liked. We want to know the other person enjoys being with us. It's the knowledge that the good in us is recognized and appreciated.

This is especially true of kids, who are kind of a chore sometimes and are generally aware of it long before they are able to not be a chore. They know their parents love them, that their parents have to love them, but it doesn't feel good to know that you are loved just for duty, that your presence doesn't make your parents happy.

Obviously this isn't something you can force as easily as "willing the good." You can force yourself to work toward anyone's good, no matter how awful they are, but to like someone, there has to be something good about them. Plus, when you're exhausted or depressed, it can be hard to delight in your kids.

Still. It's important to remember that appreciating what a child (or anyone) has to offer us isn't purely selfish. It's giving them a chance to feel good and worthy. So I've been trying to remember to both say and show to my children that I like being around them. That, sure, some games I play with them purely because they beg me to, but some things I truly do enjoy. I love taking my kids on walks in the woods. I like hearing the ideas they come up with. I like listening to an audiobook or watching a good show together. And it's important that I make that obvious--that my kids know I'm not their grudging servant, I'm a person who is honestly lucky to have such delightful children.

We enable this

Warning: post is about child harm.

There was an awful tragedy in our town last year.  A mother of twin toddlers went to work, and since her usual babysitting fell through, she left the twins in the care of her boyfriend, who lived with her.  While she was gone, the boyfriend beat both twins severely, killing one of them.

The murderer, of course, went to prison.  What surprised me was that the mother was also charged, on the argument that this couldn't have been the first time he abused them, and she had to have known.  No one else had had any reason to suspect abuse--the babysitter never saw any sign, nor the pediatrician--but the opinion of the town seems to be adamant that she did know.  I was horrified by the bile expressed toward her online, saying that if the judge didn't give her the death penalty, somebody else would.  Someone slipped her a razor blade while she was in prison and urged her to kill herself.

What gets me, what really gets me, is that all those same people who are utterly without mercy toward this mother because she should have known, are also the people who think parents who don't spank are neglectful, how in their day they got the belt and were better for it.  I even heard a man commenting at the library the other day that he moved here because my town is a lot friendlier to corporal punishment and in the liberal town he'd moved from, "you can't raise your kids right."  Certainly this town is big into spanking.  Everyone does it, everyone is proud of doing it, and they do it in public sometimes.  Any and all problems a child has are put down to weak parents who don't know when to smack.

And it just boggles my mind that nobody connects these dots.  How is anyone supposed to recognize abusive behavior when hitting children is okay?  Exactly at what moment is the mother supposed to know to call the cops?

I have known friends in similar situations and they don't know when to call the cops.  Because yeah, he blew up and he spanked the kids when we're not a spanking family, but spanking's not a crime.  Or he jerks them around, shakes them, screams at them, but well, he didn't leave a mark.

I listened to a comedy routine the other day where a dad talked about having choked his son for using a bad word.  Hopefully he didn't really do that, but how would you know?  Because hurting kids is something we joke about.  Because hurting kids is normal.  As long as you didn't cause any sort of permanent harm, it's considered discipline.  Even if you were angry and out of control, because nobody's perfect.

I just hear and see all these things and it hurts me to think about.  It makes me so angry.  Children die of being hit by parents and caregivers and we still can't wean ourselves off of it.  We think it's funny.  And I just don't know how we are going to stop these abusers before they kill a child if the line between legal and illegal is drawn as far out as it is.

This has been a rant.  Sorry to be such a downer but, man, we gotta talk about this and stop doing this, like, yesterday.

Cracking the code on sibling rivalry

"Sibling rivalry" is a weak phrase for what I've actually experienced with my kids.  My brother and I had a "rivalry."  My children fight to the death.

Over the years, I've tried a lot of things from "let them duke it out, eventually they'll find it wasn't worth it," to "leap to intervene asap" to "punish both kids."  The trouble with options one and three is that the kids already don't like fighting, they simply don't have the knowledge or maturity to avoid it.  And the trouble with option two is that I'm only one person and after the first few dozen times dragging children apart, I get exhausted.

But things have gotten a lot better recently, and I feel like I have some level of a handle on the reasons they fight and how to prevent them.  Don't get me wrong, part of the reason things are better now is that my children are older.  It is possible that any family with an autistic four-year-old, a two-year-old, and an infant is going to involve a lot of kicking and biting, because none of the children has the self-control not to behave that way.  But I'm going to take credit for at least some of the improvement, because I notice it quickly when I implement my ideas.

Basically, my system is to stop waiting for fights to break out, and start orchestrating positive interactions ahead of time.  I used to think micromanaging children's interactions was too helicoptery, but given the amount of conflict we had, it really is necessary.  I am starting with the assumption that my children want to get along with each other but don't know how.  So I need to be very involved, at least some of the time, to teach them directly the many skills that go into getting along with a peer.

I mean, what are the reasons for conflict among children?  One of the biggest reasons is a lack of understanding.  One child thinks his sister is going to push him, when she was just trying to get by.  Or she thinks the comment her brother made was specifically intended to upset her, when it wasn't.

Another reason is the lack of self-control; a child quickly escalates from "someone offended me" to smacking without a whole lot of thought going into it. 

A third reason is that a child is rankling over something that happened earlier, and is seeing a sibling as an enemy till further notice.

The last reason that comes to mind is that children don't know how to negotiate for compromises, so they assume that anyone who isn't doing exactly what they want is going to do nothing they want.

So, watching their interaction, I can often intervene at the point when trouble first starts to brew.  For instance, Michael says "I'm a lion" and Miriam starts to shriek because she thinks this means no one is going to play princesses.  I can quickly jump in and say, "Michael, Miriam wants to play princesses instead.  Can this be a princess game with lions in it?"  Often this is all it takes.  Or, "Marko, Miriam isn't going to hit you, she was hoping she could hug you, is that okay?"  Or, "Michael is pretending we're in the North Pole, he's not saying wrong things on purpose to upset you."  That helps a lot.

Another thing, which I've mentioned before, is making sure kids are aware that I will intervene quickly.  When I physically stop fights as soon as they start, or before the first blow falls, they stop being so hypervigilant and seeing conflict everywhere.  And when I verbally scold or give a timeout to the aggressor, the victim gets over their offense a lot faster.  They want to know that something has been done to ensure it won't happen again.

Last of all, and this is something that can be done at any time, is to just take over and organize positive interactions among the kids.  Very often they would like to play together but can't think of a game they all like.  Or they'd like to play together but don't know how to start.  Or sometimes one kid is feeling crabby at another, so getting just those two together and suggesting some fun things they can do goes for a lot.

All of this is especially important in our family, because Marko is the oldest and frankly terrible at the leadership skills other oldest children often have.  But it helps all the kids.  They're learning, bit by bit, that if they want to play with their siblings, or they want to feel that their siblings like them, they have to start something.  Sometimes Marko thinks the others don't like him, so I encourage him to do something nice for them.  Sure enough, they are happy about that and do it back to him.  They give each other thumbs-ups and hugs and offer to share favorite toys.

I have had this fear, ever since the boys were three and one and started fighting over everything, that my kids were going to grow up hating each other.  So far, that isn't so.  But it does take a heck of a lot of work to manage.  I'm hoping as they grow in social skills and self-control, it will slowly take less.

10 plagues of families

If you have kids, you probably have sufffered a plague or two.  What do I mean?  Well, I am thinking of one month during which our family suffered fleas, mice, and flies in the house, all at once.  My mom joked that it was like the plagues of Egypt!  And she wasn't wrong.

The more kids you have, the harder it is to get rid of some of these, because they pass things among themselves.  Sometimes we've gone months where we can't meet up with anybody because we've all got something contagious.  Venture out just once, and we bring home something else!  This is one of those times; we've had colds, fevers, and sore throats circulating among us since school started.  It's pretty horrible, but on the bright side -- it's not vomiting!

Here are the ten plagues I know most about.  None of this constitutes an admission that we've had any of these!  I admit, some of these are nasty and embarrassing.  But that's all the more reason to find out what they are and how to deal with them before they happen to you.

1. Ants

Let's start out with something not too scary: ants.  I hate them, especially if they get on me.  Nothing like sitting on the ground and then finding out you sat on an anthill.  But in the house, they're more an annoyance than a threat.  You find lines of them getting under your door or through the cracks in your window frame, and they just keep coming back.

How to prevent them: Don't leave food around.  Easier said than done!  It's a good policy to keep food contained in the kitchen and dining room only, not all over the house, especially not in carpeted areas where it's hard to clean the crumbs.  Store food in places the ants can't get to, like in the fridge or in sealed containers. We keep pet food in sealed pails because the ants were getting into it when we left it in the bag.

How to get rid of them: For an occasional ant trail, wipe down the area where they are walking.  This erases the chemical trail they lay, so they aren't able to find their way back where they were.  The best thing for this is probably citrus vinegar -- vinegar you've soaked citrus peels in for a week or more.  Ants hate it and run like crazy if you spray it near them.

For a more serious problem, those little plastic ant traps are the best.  They have poison, but the poison doesn't touch any of your stuff.  Still, keep them out of reach of curious toddlers.  You can put them out at night, inside cupboards, or on counters where ants have been spotted.

If there's a certain spot you are always finding them, you might consider sealing the cracks if possible.  Or, if there's a nest very close to your door, you could pour water on it steadily for a day or two (leave the hose trickling on the nest), making it an inhospitable spot for them.  I had great luck with this when the nest was inside a flower box outside.

2. Fruit flies

How to prevent: Again, don't leave food out!  If you keep tomatoes on the counter (which you should, they aren't good refrigerated), check them daily and use or throw away any that has cracked skin.  The same goes for any other room-temperature food, especially fruits and vegetables.  If you have a frequent problem, you might want to confine fruit to inside a cupboard or under a cloth.  Take out the trash every couple of days, even if it's not full, and throw out a compost bucket daily.

How to cure: Clean up all food fragments.  Sweep the floor and wipe down the counters.  Pour boiling water down your drains, because they like to breed down there (ew!).  Then make a fruit fly trap: one piece of fruit or some fruit juice or cider vinegar, in a jar of water, with a squirt of dish soap.  You don't need to cover the container; when the fruit flies land on the water to taste it, the dish soap makes them sink.  You'll see them at the bottom of your jar.

3. Mice

Our old house was prone to mice.  I'm not scared of mice, but I didn't like finding their droppings in my silverware drawer either.  A couple of them, I was able to catch with oven mitts on (you don't want to risk them biting you) but in the end I had to resort to traps.

How to know you have them: Little black droppings like black tic-tacs are an obvious sign.  So are chewed holes in food packages.  You may not see any mice at all, but if you have these signs, you have mice.

How to prevent: Block up holes leading into your house.  Our weak point was the gap around the oil pipe leading into our basement.  Some expanding foam took care of that easily.  You can also plug any mouse holes you find within the house, where they might hide or travel from room to room.

How to cure: Those cheap spring traps are really the best option.  Poison is dangerous to have around, and you run the risk the mice will die inside your walls.  The smell is unbearable when this happens, and you basically have to wait for a month or so while the corpse rots away.  Don't do it!  Get the spring traps from the hardware store and put them out, with a bit of peanut butter on the pedal, wherever you saw mice.  When you find a mouse in one, it will probably be dead (they usually kill instantly, which is at least humane) but if it isn't, you'll have to put on heavy gloves to handle it.  It's up to you what you do with it at that point, but let me warn you -- if you catch and release, and you haven't blocked all your holes, the cute little mousey will be right back in your kitchen with its uncute droppings by tomorrow.

4. Fleas

Fleas are both unpleasant and embarrassing.  You don't want to have friends over and have them discover you have fleas -- much less carry them home!  But if your pets are bringing them in, they can get out of control before you even notice them.

How to know you have them: A pet who has fleas will scratch a lot.  You may not see any fleas, but if you brush the pet over a light-colored surface, black "dirt" will fall out of their coat.  Get the "dirt" wet, and it turns a rusty color.  That's the flea's poop, which contains your pet's blood.  If you see it, it's a sure thing, whether or not you see any fleas.  A flea infestation may also be discovered when you find bites.  They are red, flat circles, often in a pattern, like the flea was grazing along your leg.  If you're awake when you get them, flea bites sting.  Later, they itch.

How to prevent:  Talk to your vet about the best flea prevention for your pet.  The drop-on-the-back-of-the-neck kinds are really effective, but they can make your pet sick, and they're not safe for children who snuggle the animal either.  Frequent flea baths and combing are toxin-free.  Simplest of all is to keep your cats inside and walk your dogs instead of letting them roam outside.  If your pet picks up fleas in your yard, it is possible to get the yard sprayed for them.  If your pet always sleeps on the same bedding, wash it weekly.

How to get rid of them: Oh, we tried so many things, in an effort to stay all-natural.  We swept, we vacuumed.  The eggs and larvae hatch and grow in the environment, not on the pet, so if you can keep them out of the environment, the cycle will be broken.  However, that's pretty near impossible to do.  We stripped all the beds and put all bedding and rugs in the laundry room.  Started washing and drying the stuff, only to find out that heat and humidity (which was put out by the dryer) triggers hatching.  Within a day there were fleas so thickly in the laundry room that to go in there, you had to pull socks on over your pants to avoid having them go up your clothes.  Then when you came out you had to rip off all your clothes and throw them back in the laundry room, because they were hopping with fleas.  It was a nightmare.  We dumped diatomaceous earth, we made traps with lightbulbs shining into bowls, and these things only made tiny dents in the problem.  So in the end we turned to chemicals.  This is the stuff: Ultracide.  You spray it on all the carpets and upholstery and baseboards, then spray again a week later when the eggs hatch.  It's not supposed to be toxic for humans, but I did take the kids out of the house for awhile while John sprayed.  It worked immediately and (perhaps in part thanks to many miserable baths for the cat and dog, and much flea-combing) the fleas never returned.

5. Pinworms

These are disgusting, but they say most kids get them at least once.  So try to make it through this section, because you're going to need to know.  Children ingest the eggs, and the worms live in their gut for about 1-2 months before starting to lay their eggs at night on the child's anus, causing intense itching and sleeplessness.  They aren't harmful except for the itching, but you should still treat them immediately so you don't spread them to other children.

How to prevent them: Have children wash hands after playing in playgrounds or other public areas.  Encourage kids not to suck thumbs, pick noses, or bite nails.  The eggs stay on surfaces, and children who are always touching their mouths will ingest them.  Direct contact isn't necessary for them to be infected.

How to know you have them:  Children will wake up screaming at night and wailing that their butts itch.  If more than one kid is doing it and you don't see rashes, I'd consider that a positive diagnosis on its own.  But a doctor can look for eggs with swab and a microscope.  You won't see the worms themselves unless you get a flashlight and look at your child's butt at night.  They are about half an inch long, white, and as thin as a thread.  If you get infected, you'll notice intense itching that you really cannot ignore.  Mild itching when reading this post is probably psychosomatic.

How to deal with them:  There's a medicine you can buy, which is sometimes shelved with the first aid stuff and lice treatments, and sometimes behind the pharamcy counter, called pyrantel pamoate.  You do not need a prescription.  Everyone in the family should be treated, with the exception of infants and pregnant women, who shouldn't have the medicine.  (The worms will clear after a few months, provided you are scrupulous with hygiene to not reinfect anyone.  Don't even try that route with toddlers, they are just not clean enough.)  After everyone has had a dose, it's time to clean.  Wash all bedding, cut everyone's nails, wipe down surfaces.  You may want to do all this again in a week, because that is how long the eggs live.  Keep kids, as much as possible, from scratching, and make sure they wear underwear or diapers at all times.  They can have a bath, but make sure it's hot and involves soap.  No swimming or wading pools.  Within a couple days, the itching will go away.

 A week or two later, give everyone a second dose.  You may think you got rid of them the first time, but the kids have almost certainly reinfected themselves.  A second dose will kill all the juvenile worms in their guts.  If you don't do this, two months from now they'll all be screaming at night again and you'll wonder where they got it this time.  Answer: they got it from themselves.  That is how long their life cycle is.  The second dose prevents this and hopefully you won't ever have to deal with the disgusting creatures again.

6. Impetigo

Impetigo is a staph infection of the skin.  It's usually not serious, though it can get bad if you leave it too long untreated.  And it's very catchy -- the doctor told us he once treated a family of ten that all had it.  Imagine the cost of ten doctor visits.  Yeah, don't let this get out of hand.

How to prevent: Put neosporin or another antibiotic ointment on all cuts and scrapes.  Neosporin kills most strains of staph, which usually gets in through small cuts.  If one child has it, avoid sharing cups, utensils, and food.

How to know you have it: Sores like bad cold sores, whether on the mouth or elsewhere on the body.  They might be blistery-looking, oozy, or even green or purple.  Basically they look nasty and infected, and may grow instead of healing.  Impetigo by the mouth looks almost exactly the same as herpes cold sores, but the good news is, you don't really have to know which it is.  Antibiotic ointment will cure it if it's impetigo, and if it's a cold sore, it will heal on its own.

How to treat it: If neosporin doesn't work, or if you're first noticing it and the child has multiple large sores, take them in to the doctor and get prescription ointment.  The doctor may also prescribe an oral antibiotic.  If it's just one spot and it's small, go ahead and try neosporin first.  If it's working, the sore will start shrinking within a day or two.

7. Stomach virus

The bane of all families everywhere.  If one child gets it, you're all doomed.  I hardly know which is worse -- for everyone to be puking at once, or for you to drop one at a time, so that it takes ages before everyone is well again.

How you know you have it: Oh, you know.  Vomiting is not something you can miss!  If anyone has vomited in the last 24 hours, just assume it's a virus.  It might be food poisoning, it might be carsickness, it might be choking, but can you really take the risk?  Unless you are positive it's something else, stay home for 24 hours after an isolated case of vomiting and 48 hours after full-blown illness.

How to prevent it: Never ever for any reason go over to the house of someone who has just had it, or have a playdate with someone who might have it.  The virus lives up to a week on surfaces and is extremely catching.  It can't hurt to wash your hands often and avoid touching your face, but if you have children, you can safely assume that any contact with the virus will result in illness.  I once got it from my siblings a solid week after they'd gotten better.  Spent half my Christmas vacation in a sleeping bag feeling the room spin and wishing for just one sip of water, which I knew I couldn't keep down.

How to cure: Alas, you can't.  I have heard of drinking grape juice as soon as you feel queasy, but I have no idea if this works.  Just wait it out.  Give children small sips of water or pedialyte -- no food until they've been vomit-free on fluids for several hours.  Infants may breastfeed, but what I do is nurse on one side only, so they're getting a bit less than usual.  That way they're getting some fluids but not too much.

Children cannot possibly make it to the toilet in the time it takes them to realize they're about to barf, so give each child a bowl to hold in their lap or put beside their bed.  Wrap everyone in easily-washed blankets and keep rags handy.  If you are puking yourself, taking care of them may be very difficult.  Keep the TV on and everything you need handy.  I wish you could get help, but unfortunately anyone who helps you WILL get it, so most likely no one will want to do that.  If they offer, they clearly would take a bullet for you.

When the children start to recover and are asking for food, start slow.  Do the BRATY diet -- bananas, rice, applesauce, toast, and yogurt.  Start with a bite or two, wait a bit, then let them have more.  Once everyone in the family is well, wipe down all surfaces with lysol, bleach, or straight vinegar.  Don't invite anyone over for at least a week, but the family can go places again once everyone has been vomit-free for 48 hours.

8. Carpenter bees

So much less of a big deal than germs.  Carpenter bees are big bumblebees that come out in about May and eat holes in your deck.  They like untreated wood best -- fences, porches, trellises.  Mostly a nuisance, but if you let them be, they'll eventually destroy all your wooden things.

How you know you have them: Holes appear in your wood, about a quarter to half an inch around.  They're slanted, so you won't see inside very well.  Sawdust may appear below the hole.  And in the spring, big black bumbling bees fly around.  They rarely sting, but my kids are terrified of them anyway.

How to prevent: Treat all wood in your yard by painting or sealing it.  Once you've got the bees, they may not be deterred, but if you don't have them yet, they will probably not get established.

How to cure: Traps are the best way.  This kind can be made yourself, or your hardware or garden store might have them.  At first, our trap didn't catch anything.  I heard it was because they prefer weathered wood and it was brand new.  But elsewhere I heard that you can attract bees by catching a female bee (the one with a black head) in the jar.  I happened to find one stuck on our screen porch, so I scooped it into the jar.  Sure enough, by the next day I was starting to catch bees.  They prefer pre-existing holes to having to chew new ones, so you'll catch more if you plug up all their old holes with caulk, wood glue, or expanding foam.

9. Bathroom mildew

Mildew is just gross-looking.  It's never caused us any harm, but I still don't like it and want it gone.

How to know you have it: black or gray patches growing on your bathroom ceiling, toilet lid, or any other damp place.  How do you know it's not dangerous black mold?  Well, the main way is that mildew comes right off, while black mold doesn't.  Here are some more tips.

How to prevent it: Ventilate your bathroom.  If it has a fan, turn it on when you shower.  If it has a window, open it after you shower.  There is mildew-proof primer you can paint your bathroom with, which may help.  Hang towels where they have air all around them, and spread out the shower curtain to dry.

How to cure it: Scrub it down every time it starts to reappear.  I use straight vinegar but bleach will also work.

10. The common cold

Alas, much, much too common.  We've been passing around different strains of it since school started.  It's usually no more than a nuisance, but coughing and stuffy noses can interfere with sleep.  And sometimes children get fevers even with colds that give adults few or no symptoms.

How to prevent it: Wash hands.  I know.  Encourage kids not to touch their faces.  One of the most common places they'll get a cold is from you, the parent, so try not to swap germs with them more often than you have to.  If you go somewhere without them, or the other parent does, wash hands when you get home.  Each child should have their own sippy cup rather than drinking yours.

How to know you have it: You know the drill: sore throat, runny nose, sinus headache, cough.  With a baby who can't talk, you'll only see the snot, so very often the first day of the cold, they'll just be inexplicably fussy.  Then the next day, they have a runny nose, and you're like "ohhhhhh."  The main difference between colds and allergies is that colds have a progression of symptoms while allergies keep the same set of symptoms, just more or less off them, as long as you have them.

How to cope with it: You can't cure it, obviously.  But plenty of rest will help everyone get through it as painlessly as possible.  A day off school isn't a bad idea.  I like to make chicken soup with lemon, garlic, ginger, and cayenne -- it really blasts the yucky feeling away.  Medicine isn't really necessary unless people feel really awful.  Unfortunately, cough medicine isn't available for children under four, but for older children you can give some before bed.  For sore throats, sore ears, and sinus headaches, ibuprofen or tylenol are available.  Ibuprofen works better and lasts longer, and there's less risk of overdose, so it's what I choose.

If their forehead feels hotter than usual, as well as dry, they probably have a fever.  (A hot face and neck is common with a cold even if they don't have a fever.)  I leave it alone unless the child is very distressed and uncomfortable, or if they can't sleep.  If it gets over 102, it's good to bring it down with ibuprofen.  They say medicating a fever doesn't make it less effective, but it can make a child feel so much better he goes back to playing, while a fever will make them rest.  With a baby, if they're not medicated, I keep them against my body as much as possible, so that I have a sense of how hot they are and my body will cool them down.  You really break a sweat doing this.

If a child has a fever, keep them home for 24 hours afterward.  Fevers often peak at night, so never assume that a fever that disappears in the morning is gone for good.  It could come back later.


Best wishes, and I hope all these plagues stay clear of your family!  But if they do befall you, I hope my experience helps you out.

Hobbesian parenting

Years ago I wrote a post about libertarian parenting.  I still believe in giving kids freedom to do what they want within reason, but experience showed that there's only so libertarian you can be as a parent.  I don't just mean "kids are a bit dumb and would forget to eat or sleep if we weren't there to make them," which is true as far as it goes.  A little gentle direction usually is about enough, so actual forceful interventions don't have to be an everyday occurrence.

However, I never could figure out how to deal with violence in a "libertarian" way.  Nobody should have the liberty to hurt anybody else.  I asked in my libertarian parenting group what you do when kids fight, and they mostly just said, "Fighting is against the non-aggression principle so I don't allow it."  Well, yeah, but what do you do to stop it?  Do you (as some libertarians argue) have the right to take any action you want so long as you weren't the one to initiate aggression?  On the other hand, since you weren't the one attacked, perhaps you have no right to intervene and your bullied toddler has to duke it out on their own.

I did try, for awhile, the "just let them work it out" approach.  I thought that perhaps they fought so fiercely because they were relying on me to swoop in and sort things out, and thus if I kept out of it they would eventually realize they should watch their behavior.  But it didn't help at all.  Things got worse and it seemed every day the kids woke up with a chip on their shoulder against the other one.  It was a textbook example of a cycle of violence, enacted daily by preschoolers.  Not good.

From watching my kids, I learned the flaws of radical libertarianism, or anarchy. (Anarchists often call themselves "libertarian," but real libertarians usually agree that the government has a role of defense and crime prevention, so I'm going to leave the libertarians alone from here on and speak specifically to anarchists, who made up 90% of my "libertarian parenting" group.)  Flaws like these:

1.  Not everyone follows the non-aggression principle.  This is obvious, right?  The reason no anarchist utopia has ever worked out is that people keep conquering anybody that tries.  Of course anarchy tries to deal with this by claiming that when bad guys attack, anarchists will voluntarily band together to defend themselves.  But ...

2.  Not everyone is equally strong.  So a sufficiently powerful enemy can wipe you out.  This is easily observed when my kids get in a fight.  Do I really want things to settle into a "peace" where the bigger or more aggressive kid beats up everyone else?  Because kids are kind of famous for getting into these social hierarchies when they're left alone.  (In some cases, they don't, and I'm not entirely sure why, but suffice it to say that whatever I was doing was insufficient.)

3.  Not everyone agrees on what aggression is.  Is humming while someone else is trying to play the piano aggression?  What about breathing on someone?  What about eating their food when you thought they were finished with it, but it turns out they're not?  What if you accidentally brush against them and they think you bumped them on purpose and clobber you, does that make them the aggressor and are you allowed to hit them back?  These questions come up ... kind of a lot around here.

4.  People (children especially) are not always rational, and sometimes they get carried away.  So rather than simply defending themselves, they try to avenge themselves.  Or they see a sibling coming and panic and hit first.  Adults do the same, cf. Afghanistan.

Anarchy provides principles which would work if everyone followed them, mostly, but it has no way to get people to follow them, to account for human nature, or to de-escalate violence once it's begun.  So it's not really very useful for this.  (Anarchist communes that take place under the auspices of some other government sound lovely, but of course they rely on the government defending their title to the land, arresting trespassers and other offenders, and generally providing a safe place to be an anarchist.)

Hobbes has the answer to all this, and I never knew it because my poli-sci class was mostly spittle-flecked rants that you could safely tune out because the professor wanted you to just find an old test and memorize the answers.  *still bitter*  And we spent, like, one day on Hobbes.

Hobbes gives three reasons why conflict begins: competition, defense, and reputation.  Let's take a few kid examples:

Competition, or gain: Michael sees a toy Marko has and wants it.  He's hoping he can get away with taking it, so he snatches it.

Defense: Marko sees Michael going for his toy, so he shoves him away from it.  Quizzed about it after, he'll say, "I wasn't TRYING to hurt him, I was just trying to make him stop taking my toy!"

Reputation: After having been shoved by Marko, Michael leaps to his feet.  He knows that if Marko hits him and gets away with it, he's going to do it more, so he punches Marko in revenge.  His revenge is disproportionate to the amount he was hurt, partly because he's angry and not in good control of himself, and partly because he rationally wants to let Marko know he's not to be messed with.

Once the fight has started, it's bound to continue to escalate.  Each becomes suspicious of the other and sees the worst in all the other's behavior.  If they tried nonviolence, it would surely help, but they're all afraid to because they might be taken advantage of.

There is one thing that can help: the Leviathan.  I mean me.  In a family, the parent takes the role of government.  I can prevent all three causes of violence.

Gain: Every time one child steals from another, I can make them give the toy back.  That way snatching ceases to be a useful behavior, and children do it less.

Defense: They know that if they are attacked, I will help them.  If I were faster it would help even more, but even at my delayed response rate, they are assured that yelling "Mama" will get me to come peel the attacker off them.  So about half the time at least, they choose that approach over the attack-back (or pre-emptive attack) method.

Reputation: If they revenge their own wrongs, they always overdo it.  But if I assure them that I will give some kind of consequence to the attacker, they are more willing to accept it.  I still think that the desire for vengeance is one of the dark sides of human nature, but it's there.  If I don't punish the offender, they will.  The goal is to reassure the child that you've done what it will take to convince their attacker not to do it again.  When I'm not going to punish the child -- like when Miriam was the attacker and I know she's just being tired and cranky so a timeout isn't really going to be helpful -- I still take her out of the room so the boys think she is getting punished.  And when the attacker is someone completely irrational -- like Jackie, or the dog -- I still give them a little lecture: "Gilbert, you must be more careful!  No stepping on people's feet!"  Somehow the kids consider this satisfactory.  But they do demand that something is done, and I'm beginning to see the sense in it -- they fear that if their attacker is allowed to get off scot-free, they'll do it again.

The Better Angels of Our Nature explained this stuff a lot, pointing out that honor culture flourishes in places where there is little or no government, whereas a strong government gets wronged people to press charges, file a lawsuit, or mutter "there oughta be a law."  When there is no higher authority for people to appeal to -- like in a corrupt state, or when kids are left unattended -- people feel they must create fairness for themselves through vengeance and preemptive attacks.

It's important that the Leviathan is separate from the parties it's arbiting among, and that it is stronger than any of them.  Obviously an arbitor that is obviously partial, or which can't enforce its judgments, is no different from none at all.  That's pretty easy in my case, though -- I am definitely a lot bigger than my kids, and I'm not a part of any of their fights.

The embarrassing part is that it took me so many years after first "studying" Hobbes to figure this out.  I had thought Hobbes was the bad guy.  Turns out all he was saying was, "Without some way to arbitrate disputes, life is going to be nasty, brutish, and short."  Or,  ya know, full of squabbles over toys wherein everyone winds up covered in teeth marks.

Why I'm finally vaccinating my kids

Part 1: My story

As regular readers know, until recently, all of my kids were unvaccinated.  That was for a lot of reasons, but the main was that John was strongly opposed.  He believed that vaccines caused autism, and he didn't have much trust in doctors.  I didn't have a strong opinion on that matter at the time, so I said that would be fine.  Later, when I began to research the issue, I admit that my reasoning was somewhat motivated -- since I had already agreed not to vaccinate the kids, I didn't really want to find anything that would convince me differently.  However I did think that I might reopen a discussion the subject when the kids were a little older -- perhaps a few vaccines after the age of two.

My main worries with vaccines were serious reactions or death.  I saw a photo of a child that had died of a severe allergy to the Hepatitis B shot, and it really horrified me.  It just seemed to me that giving a vaccine shortly after birth means you don't know what allergies they might have, whereas if the baby had been vaccinated at six months or a year old, the parents surely would have discovered his allergy by then.  Another worry was SIDS, because I'd read some articles suggesting that vaccines at two and four months were the real cause of SIDS.  And I do know that encephalitis can be a real vaccine reaction -- albeit a very rare one.

I spent some time trying to find out which was more likely, a vaccine reaction or my child catching a vaccine-preventable disease.  But this was impossible to discover, because official sources (like the CDC) claimed that serious vaccine reactions were extremely rare, while more "alternative" sources said they were extremely common and covered up by the medical establishment.  In some cases they also denied that vaccine-preventable diseases were dangerous, or that they were even caused by viruses at all (for instance, they claimed that polio was actually caused by pesticides).  So if I chose a source to listen to, the decision would be easy; each had quite a convincing argument with the facts they had.  But I couldn't find any common ground on the facts, which I could use to prove one or the other correct.

At the time, though, I was pretty anti-authoritarian, and the idea that the entire medical establishment was in a conspiracy to poison my children seemed pretty credible.  After all, I knew just how flawed the medical community could be where childbirth was concerned, so why not vaccines?  You don't need to be an evil person to be part of a conspiracy like this.  You just have to be convinced it's for the greater good.

And then, of course, I read Evidence of Harm and it definitely played up the conspiracy angle.  There are things that don't quite fit in that book, but it's just so packed with difficult scientific ideas it can be a little hard to catch.  Whether vaccines caused autism wasn't really a big question for me, because, I mean, autism isn't death, and if it was a choice between having an autistic kid and having a kid die of tetanus, I'd pick having an ALIVE kid.  But it did make me think there might be a connection.  I mean, look at those skyrocketing rates!

The shift in my thinking happened very slowly.  I started occasionally finding out that the government, for instance, wasn't all evil, and that some regulations actually had good reasons for existing.  John won a seat on town council and immediately started finding out that government wasn't so evil as all that.  Yes, sometimes it was incompetent and slow, but the people meant well and what's more, sometimes I found the right answer was the government answer.  Like the way this town has tons of unsafe slums, which the free market hasn't done a thing to fix -- rental codes probably are the answer, even if someone looking at them for the first time might think they were too burdensome and detailed.

I started to feel more friendly to the medical establishment thanks to having good doctors instead of that mean one who fired Marko from his practice for not being caught up on vaccines.  Our current doctor is a really sweet guy who respects my decisions as a parent and never pressured me to vaccinate.  Yet many times when my kids had minor problems, he helped in ways I couldn't have on my own.  He knew that Michael's round rash was ringworm and not Lyme disease.  When Miriam had impetigo, he prescribed antibiotics that started working within a day, after my home remedies had failed.  I started to realize that he (like most doctors) cared about his patients and had knowledge I didn't.  They're not all that nasty obstetrician who wanted to give me an episiotomy without asking.

I also learned how science works, something that I wasn't really taught in school. In school they teach you the conclusions that science has come to, but they don't really explain where each discovery comes from.  I learned how to read a study, that a review of many studies is better than an individual study, that a large sample size is better than a small one, that a randomized, controlled trial is better than an epidemiological study.  I learned that it's possible to "chop" the data you get in a study to get the results you want, and that peer review helps catch that sort of shenanigans.  And I did start to notice that most of the really high-value studies were on the side of "vaccines are safe and effective" while many of the anti-vaccine studies were small and weak.

Most of all, I realized that alternative medicine practitioners are no less likely to be sleazy than real doctors, and in fact there are fewer safeguards to prevent them from being sleazy.  "Follow the money" is often used to mean "look, these studies can't be trusted because some of them were funded by pharmaceutical companies," and yet very often alternative practitioners make huge amounts of money from the treatments they peddle.  Desperate people, who have been taught to be afraid of conventional medicine, pay more than they can afford in the hopes of curing ailments which conventional doctors have told them can't be cured.  The quacks take their money and over-advertise their treatments, trying to convince sick people that they can cure things which have no cure.  Today I read a sad article about people with ALS or other incurable conditions being told they had "chronic Lyme" and spending tens of thousands of dollars on treatment that did nothing and sometimes caused harm.

Basically, no one is entirely to be trusted, but if you have to trust somebody, doctors are probably a better choice because they have more oversight.  Scientists work to create a standard of care for each condition which is proven to be safe and effective; a doctor who doesn't follow it or who is careless is subject to malpractice suits or even jail time.  Whereas alternative practitioners sometimes don't have any oversight at all.  And when you hear of this guy going to jail for malpractice, and that guy losing his license, and this guy is marketing cyanide for cancer treatments, and so on,  you start losing faith in the alternative medicine community.  You might not have proof that they are lying about vaccines being dangerous, but when they lie about so much other stuff (or are just dead wrong in obvious ways) you don't have a lot of confidence.

The last step was when, two years ago or so, I started making serious efforts to be more rational in my decisionmaking.  I realized that my instinctive fear of needles and medical stuff was affecting my judgment.  I also had reasoned in the past that it was better to run the risk of my child dying from something I didn't do than from something I did, because I would feel more at fault in the latter case.  But I realized that whether I would feel more at fault wasn't actually a moral consideration, it was simply an emotion of mine which had no bearing on whether or not I was actually responsible.  We're responsible for our actions and our omissions; inaction isn't a guarantee of not making a moral error.  I also got into Kant a little bit.  Kant says that we should always act in a way we would like everyone to take as a moral rule.  I didn't want everyone to not vaccinate -- I wanted them to continue vaccinating so polio and diphtheria didn't circulate, while at the same time personally opting out.  And that is just not fair.

There was awhile there where I thought vaccination wasn't dangerous but thought John disagreed with me.  And then I found out he also had changed his mind about it, but I was too overwhelmed with life to do anything about it.  And then I found out that if we wanted to put the boys in school, we had to get on it Right Away, and actually Yesterday.  They're not going to be fully vaccinated in time for school to start, because of how they have to be spaced.  But the health department has been wonderful working with us -- they made a nice catch-up schedule for us (at their age they don't need so many doses as a baby would) and will certify for the school that the kids are in process to be vaccinated and should be allowed to attend school.  There was zero judgment about having waited this long and they have respected my right to choose what they get when.  The health department is ten minutes from my house, has lots of available appointment slots, and gives all legally mandated vaccines for free to all uninsured patients, or if your insurance does not pay for them.  I highly recommend your local health department if you need to get any vaccines.

Edited to add: I'll be honest, I was scared getting them their first shots. Marko was already autistic, of course, but I worried that he'd have some kind of massive regression. And that did not happen. He has made massive progress since getting vaccinated, and has never had a reaction. The other kids did not develop any autism symptoms either.

Part 2: Answers to objections

So that's the personal-journey part of this post: the main reasons why I, personally, came to change my mind.  But of course there are facts in question, too, so I wanted to address some of the specific arguments that I found convincing against vaccines, and explain why they don't bother me anymore.

1.  Vaccines and all-cause death

If vaccines increased the risk of death, one would expect infant and child mortality to be increasing right now.  But as the number of vaccines has risen, infant and child mortality have dropped.  These charts start in the 80's, so we're not talking about the invention of sanitation and antibiotics.  There have been many medical advances in that time, but that does include vaccines, so it seems plausible to me that some of the reduction in mortality is due to them.  Certainly wishing for a vanished time when everything was better and people were healthier is not based in fact.

2.  Vaccines and autism

In this case it passes the test the previous chart missed: vaccines and autism are both increasing.  The original connection was supposed to be mercury: thimerosol preservatives in vaccines contain tiny amounts of mercury, and that was hypothesized to cause brain damage.  An alternative link was in the immune system -- Dr. Andrew Wakefield thought that it was the MMR, specifically the measles virus, which was somehow active in the gut and then damaging the brain.  His study is generally agreed to be junk, but that doesn't prove his theory is wrong.  And, I mean, look at the graph!

 At first blush it's pretty convincing.  The CDC keeps adding more vaccines to the schedule, and at the same time autism is increasing --- a lot.

But let's see if we can place some important dates on this graph.  I couldn't find a graph with these dates, so we'll have to eyeball it.

1971: Invention of MMR vaccine
1989: A second dose was added to the schedule
After this, the doses of MMR remained steady at two.  So if the MMR caused autism, we would expect one jump in 1971 (or a bit after) and a second jump in 1989 (or a bit after) and then the rates of autism remain steady.  As fascinating as the gut-brain-immune system connection is, I think the MMR theory is a flop.  It can't explain the rise in autism rates.

1930's: Thimerosal first used
2001: Thimerosal is removed from all children's vaccines except for the flu vaccine.  Children get significantly less thimerosal than before, and some get none (since not all kids even get the flu vaccine; it's not usually required).
So thimerosal was present in vaccines long before the autism rates started increasing, and its removal had no effect on autism rates.  I can totally understand why people might have thought it was connected, but the past 16 years have pretty much destroyed that theory.

1980: The DSM-III (the official manual of psychological disorders) includes autism for the first time.
1987: The definition of autism is expanded in the DSM-III-R.
1988: The movie Rain Man is released, making most people aware of autism for the first time.
1991: The IDEA act makes autistic children eligible for special services.  While previously parents would try to avoid a diagnosis to keep their child from being denied an education, now they started to seek a diagnosis in order to get their children services.
2013: Asperger's Syndrome is reclassified as autism spectrum disorder and the definition of autism is expanded again.
In short, there are very good reasons why more and more kids who are no more disabled than before are getting the autism label.  Marko is one of those kids -- he is not really any more quirky than some of the older members of my family, but to get services he's been assessed a lot more thoroughly.

An objection to the increased-diagnosis theory is, "But where are all the autistic adults?  Why did I never see any severely autistic kids when I was younger?"  The answer to the second question, sadly, is "in institutions or denied any education at all."  Before 1991 it was not illegal for a school to simply tell a child's parents they couldn't provide an education for him, and that would be that.  And in answer to the first question, autistic people do continue to develop as they age.  Most autistic children grow into adults who are capable of interacting more-or-less as other people do, so you might not notice them.  They're your quirky neighbor or uncle.  I certainly know autistic adults, diagnosed or not.   And the ones who still aren't able to speak or handle a job or house ... well, where do you expect to meet them?  Interacting with you is the main thing they're not able to do!  But you can find them on Twitter and the blogosphere.  They're certainly around.

A lot of autistic children, as well, would previously have been diagnosed as intellectually disabled.  Check out this chart: as autism rose, intellectual disability decreased.  Vaccines don't cure intellectual disability -- it's almost certainly the same kids just getting reclassified.  Plus, of course, more mildly autistic children who wouldn't previously have been diagnosed with anything.  That can be shown by a study cited here showing that the average autistic child has a much milder case than the average of years ago.

Source: http://www.sciencemag.org/news/2015/07/autism-rates-are-it-really-rise

Of course when one theory is debunked, the vaccines-and-autism crowd moves to a new explanation.  So when mercury was removed, they pointed out that aluminum had been added and maybe it was causing the same brain damage.  But that doesn't make sense, because aluminum does not act in the way mercury does in the brain.  Aluminum poisoning seems to affect memory, if anything; there is no reason to expect it to act exactly the way mercury does.  I haven't yet heard a plausible theory connecting vaccines and autism besides the ones I've debunked here.

And of course anecdotal evidence can be the most powerful kind.  One single story about a child having an autistic regression after shots can outweigh all the studies you've ever read.  But in my case the anecdotal evidence is on the side of vaccines being harmless.  Marko has always been just as quirky as he is, despite not having had a single vaccine.  I will admit I was a wreck the day of the shots, terrified Marko would have a massive regression and stop speaking.  But nope.  He's had three batches of shots (including MMR, DTaP, polio, Hep B, and varicella) and is exactly as autistic as he was before.  Maybe less, because he's had a ton of gains lately, especially in verbal fluency and social skills.  It's been a huge relief to me.

3.  Vaccines and SIDS

SIDS is terrifying because we still don't really understand what causes it.  And it's true there is a spike between 2-4 months, which is around when babies get the DTaP.  But I feel pretty well convinced it's not caused by vaccines, because the spike in SIDS deaths at that age has been well-known for over a century and is the case in all countries, regardless of when first vaccines are.  Here are a couple articles demonstrating this.


Part 3: Recommendations

So with all that said, does that mean I now will abide perfectly by the recommended schedule?  Eh, probably not.  I believe that the recommended schedule is safe and is probably the best choice from a public-health perspective.  But it is also true that part of the reason vaccines are given at such early ages is because the CDC thinks we might not show up to get them later, or because we'll already be bringing in the baby for a well check so we might as well.  Not every recommendation is "do this or children die."  In our state only MMR, DTaP, varicella, polio, and Hep B are required, and the rest are only recommended, so we're getting the required ones for now.  I would get the recommended ones if I had babies in daycare, because most of these are for illnesses that are only dangerous in infants, and my babies don't get out much.  I want to give Miriam vaccines soon (though I dread it, because she'll basically have to be hogtied) and I am not sure when to give Jackie some.  Probably soon I guess?  I still really recoil at the thought of poking a tiny little baaaaaby with a needle.  But on the other hand, she's not so tiny now, and the doctors do say it's safe, so I'm sure I'm just having an emotional reaction here.  And the nice thing about vaccinating infants is, you can nurse them as the needle goes in so they barely notice.

I would definitely recommend people get at least the DTaP, since those diseases are serious, and the MMR, since they have pretty horrifying complications in a small percentage of cases.  True, if your kid got the measles, they'd probably pull through fine, but ... they might not.  They might die of encephalitis or pneumonia as a complication, or become permanently deaf or sterile.  It's not quite like the chicken pox.  Polio, I understand you have a very, very small risk of being exposed to.  It's almost eradicated worldwide.  But on the other hand it isn't gone, and people travel to America all the time from foreign countries where it exists.  We really should be careful to maintain a high vaccination rate so it doesn't return here.  On the bright side, in a decade it may be completely gone, and then, like smallpox, there will be no need to keep vaccinating for it.

I think varicella and hep-B are kind of unnecessary.  I wouldn't have gotten them on my own.  But the state doesn't really give me a choice to pick and choose.  There is a religious exemption and a medical exemption available, but to obtain either of these I would have to lie.  I don't think that's right.  Many Catholics I know claim a religious exemption when really they just don't believe in vaccines.  The only part of this equation Catholicism forbids is the lying.

Now for some recommendations for vaccine advocates.  Because I don't think they quite realize just how unhelpful some of their activism has been.  Since it's mostly a matter of trust, attacking people just makes them close ranks and trust you less.  Getting fired by a pediatrician didn't make me go "oh, guess I'll get the shots then."  It made me mistrust doctors more.  Getting called a baby killer didn't help.  Getting called stupid didn't help.  Scary stories about babies dying of preventable illnesses just gave me more to keep myself awake at night with, keeping company with the picture of the baby dying of a vaccine reaction.  More fear made things worse; it made me afraid to even think about the subject.  I know not everyone reacts this way, but some do, and it's probably best not to amp up the fear.  I generally remind people that both vaccine reactions and vaccine-preventable diseases are rare, and the most likely result is that your kids grow up perfectly healthy whatever you choose.  So all you're doing with this decision is managing extremely small amounts of risk.  Of course the most responsible thing is to pick the smallest, but this isn't quite as high-stakes as it feels.  Most people do vaccinate, and because of them, these diseases aren't all over the place the way they used to be, so you have the luxury of waffling a bit.

What does help?  Respecting people's judgment.  Building up trusting relationships.  Encouraging baby steps like actually going to the doctor at all.  Doctors should mention vaccines and then drop it, not lecture endlessly and pile on the guilt.  And people who vaccinate partially should be encouraged rather than lumped in with people who don't vaccinate at all.

And I think everyone should remember that not every person who doesn't vaccinate is completely closed to new information.  I went on a comment thread that I knew was pro-vaccination and asked for information, because I was looking into starting to vaccinate and wanted to be convinced, and instead was demonized and called names because I hadn't done it already.  I was told I was responsible for the deaths of babies - even though my kids can't very well have infected babies with diseases they've never had or been exposed to.  I was sent a link to a CDC site which stated that vaccines are safe.  Well, of course the CDC would say that, wouldn't they?  But when I asked how I could know I could trust the CDC, I was sneered at and called a conspiracy theorist.  Isn't that just what someone in a conspiracy would say? ;) I wanted to know how I could know how to trust their studies and why I shouldn't trust the studies the anti-vaccine movement had, but no one even bothered to try.

This post is meant as a bit of a counter to that attitude.  But I think the best way to encourage someone who doesn't vaccinate to start doing it is simply to have a conversation.  Start by asking why the person doesn't vaccinate -- don't assume you know!  And if they are willing to discuss it with you, research their specific objections and offer the most objective answers you can.  Be kind and show that you are really listening, not dismissing their objections out of hand.

I'll close with a story from about a year ago.  Marko had gotten interested in the immune system, so we watched a bunch of YouTube videos about white blood cells and antibodies and various diseases.  There was one about measles, which explained that the virus attacks the immune system, leaving the person vulnerable to other diseases for months afterward.  Marko found it terrifying (although it wasn't graphic or scary) because he loves his immune system and hates being sick.  "Is there a cure for the measles?" he asked.  "No," I said, "but there's a vaccine.  If you get the measles shot, you won't get the measles."  He instantly demanded, "Get me that shot, Mama!"

I guess it really hit home to me then that I was assuming the whole time that my kids wouldn't want shots.  I hated getting shots, and of course if I'd given them when Marko was a baby, he wouldn't have understood the reason and would have cried.  But given a chance, he's actually come out in favor of vaccines.  It really soothed that feeling of "I can't let my baby get such a terrible thing!" and reminded me that this is something I do because I love my children, because I know it is best for them.  Even if sometimes there are a few tears.

Attachment parenting - an inconvenient truth

I first got into attachment parenting when my younger siblings were born.  My mother had all kinds of parenting books, from the crunchy to the fundamentalist, and I used to read them all and try things out on my siblings.  But mostly I just watched what she did -- fed the babies when they were hungry, put them to sleep when they were tired, tried to comfort them when they cried.  It was very rare that she ever left any of them in the crib crying, and if she ever did, I usually ran and got them out of there because that's what you do with a crying baby, you comfort them.

So long before I had kids of my own, I had strong opinions about how I'd raise them.  And though some of them have changed a great deal -- for instance, on spanking -- the attachment stuff is all pretty much intact.  I've stopped being as legalistic about it -- I think you can be attached without necessarily breastfeeding or cosleeping, the point is that you are responsive to your children's needs and comfort them when they cry -- but the basic concept is still something I firmly believe in.  I can hardly help believing in it, it seems so instinctively right to me.  I can also testify to its effects on me -- when I am very attached and responsive to my kids, I get angry with them less and I enjoy them more.

But it's not all gut feelings here.  The science behind attachment parenting is pretty solid, as any science about parenting goes.  We've definitely seen some strong correlations between children who are fed and comforted on demand and what is called "secure attachment," and there are correlations between children who are securely attached and those who do well in school and have fewer behavior problems, less anxiety, less aggression, and so forth.

Critics of attachment parenting fall into two groups.  First are those who say, "Hey, you don't need to follow a certain set of rules to be attached!  I bottlefeed and my baby sleeps in a crib and I hate using a sling and my baby's as attached as anybody's!"  To which I say, of course!  It's easier to feed on demand when you breastfeed, and it's easier to take care of your baby's night needs when you cosleep, but if you still have the general principles in mind and are willing to go to some extra effort to make it work, I'd imagine you'd likely get the same results.

The other group disagrees with the whole premise of attachment parenting.  We shouldn't be responsive to babies, they say, because that teaches them they're in charge.  We shouldn't feed them on demand because it's important to get them on a schedule.  And you certainly shouldn't hold them too much, or they'll be spoiled.  These people claim attachment parenting creates needy babies, spoiled children, and delinquent adults.  There's no evidence that this is true, but they are usually repeating traditional arguments for the parenting practices of a few generations ago.  They are afraid that new methods are going to result in a different kind of person than they themselves are, because after all they were raised with the old methods and they like the way they turned out.

But it makes sense to me that attachment parenting has good results.  While at first it may seem intuitive that, to get a child used to giving up his own way and getting along well with others, you should make sure they don't have as much as they want of anything, social behavior usually works the opposite way.  We usually share best when we know there's enough to go around.  We are kindest when we're not afraid someone will take advantage of us.  Attachment parenting is all about teaching a child that he is safe, that there is enough of everything to go around.  These lessons aren't learned consciously in a pre-verbal child, but there is evidence that they are biochemically hard-wired into the child's brain -- high amounts of stress hormones in a developing infant can increase the intensity of his stress response for the rest of his life.

And increased stress often leads to increased aggression.  I see it with my kids daily.  When one feels threatened by another, he often lashes out.  When I ask why, the answer is, "He was going to hurt me!"  First law of the playroom, apparently, is "do unto others, before they do to you."  Diligent repetition of, "I am watching and will not let him hurt you," and follow-up as required, has cut fighting down drastically.  A year ago, when I was stretched thin with the baby and consequently didn't intervene much, both boys were constantly at each other's throats.  Now I'm more closely involved and break them up quicker, each feels safer, and by this time they hardly fight at all unless they're under some unusual stress, like being sick.

Of course, another factor here is that each is getting a lot more attention from me individually, too.  Each kid gets time on my lap every day, pretty much when they ask for it (though not entirely, because there's only one of me).  When there is some toy that's starting a fight, one kid can usually be persuaded to give up the toy and come hang out with me.

And punishment?  The less I punish, the better they are!  I can't always help it, but I find that even a time out makes them unhappy, which makes them angry, which makes them behave worse.  Whereas taking the offender on my lap and hugging them lots and talking over the issue until they don't feel upset anymore leaves them behaving better all day.  That's not how I was brought up or how I thought I would parent, but it works.  When I throw a kid in time-out, I have to deal with him invariably starting a cycle of aggression with the others as soon as he gets out.  But when we hug and talk as long as the child wants, when he's finally ready to get up, sometimes he actually goes immediately to find something kind he can do for me or the offended sibling.

But here's the "inconvenient truth" part: it is more work.

That's why the two groups that I most often hear criticizing attachment parenting are feminists and large family advocates (Quiverfull Protestants, providentialist Catholics).  The feminists say, "It's not fair that mothers have to put their career on hold to form this ideal mother-child bond.  Give the child a bottle and put him in daycare, he'll be fine."  And the large-family advocates say, "There's no way you can do all this intensive parenting when you've got more than a couple kids and they're closely spaced.  Sleep-train that baby as soon as possible; he'll be fine."

I have tried, throughout my blogging career, to either refute or hand-wave away these objections.  I believe in feminism and I used to believe in providentialism.  I wanted it to be true that you can adequately raise children while having either a career or a large, closely-spaced family.  And it almost is -- if you sacrifice yourself completely.  It helps if you have lots of support and money.  A working mother can spend most of her earnings on a nanny who will form a real bond with her child and respond to its every cry, rather than an inexpensive daycare where the baby may be left crying in a swing or crib at naptime.  A mother of many can just go without sleep for years and years and blame any failures of temper on her own lack of virtue.  But I think most of us who try are going to fail in some degree, or else go half crazy.

Focusing specifically on the large-family aspect (because it's what I know), you just can't attachment-parent a baby every year.  Having a baby every year means getting pregnant with a new baby when the old one is a few months old -- so breastfeeding's pretty much out.  That's not so bad, but of course taking care of their night needs is going to be virtually impossible, since pregnancy makes you exhausted.  Once you've got three or four at that space, you're probably hallucinating if you haven't started sleep-training them early.  And you sure as heck can't pick each one up to comfort them when you need to if you've got a lot of them -- not unless you're an octopus.

Every two years is better.  I thought it would be ample, but it really isn't.  A lot of two-year-olds don't sleep through the night, for one thing; and they need a surprising amount of snuggling.  Marko was very mature at two, I'm now realizing, and didn't need as much, but Michael still needs a heck of a lot of hands-on time.  His behavior suffers when he doesn't get it -- after Miriam was born, he went on a tear of really outrageous naughtiness that lasted for months.  And he whined and cried a large portion of every day.  He's shaped up now, thank goodness, but if I were to stay on this schedule, I'd have to get pregnant about now and then Miriam could be needy and clingy for the next year.

Three years is what Dr. Greg Popcak recommends in Parenting With Grace, a book I'd buy every new Catholic parent if I could.  I don't have my copy handy, but he had some citations to prove that three years is a good minimum spacing between kids.  Certainly, those I know who have had a space like this say it's great -- at three, a child has pretty much graduated from the really intensely attached stage and is more interested in your mental attention than physical contact.  Three-year-olds are mostly weaned, or almost weaned, even if you've nursed them on demand.  And it leaves the mother time to replenish nutrient stores, apparently, as well as to hopefully get some good night's sleep when she's pregnant because the big kid is in his own bed all night.  (Unless the big kid is Michael.  LOL.)  And it'll result in a smaller total number of children, which means you're likely to have the time to invest in working out fights instead of just spanking everyone.

Of course, some people say the important thing is to make new souls for heaven and we should give up attachment parenting to that end.  To which all I can say is -- if you just want to make the soul, and you don't care about the moral development the child has afterward, you can do as you wish.  But if the goal is heaven, it seems the moral development would matter some.  The other Catholic objection is just that a three-year gap is difficult to attain using natural family planning, to which all I can say is, Yes it is.  Sorry.  Abstinence is miserable, but it's less miserable than the knowledge that your child needs more from you than you are able to provide.  And as far as its failures go -- well, it's one of the reasons I'm convinced that following Catholic teaching does not necessarily have good results, at least on earth.

I just think that when children grow up, from the very beginning, never having had enough of anything they truly needed, whether it's food or attention from Mom, they never stop wanting it.  They may quiet down and stop asking for it, for now, but as they get older they'll still have those unmet needs.  But they won't feel safe or trusting -- they'll feel suspicious and angry.  Instead of calmly thinking through problems to find a solution that works for everyone, they'll clamor for their own piece of the pie because they're scared they won't get any.  They'll want to do to others before others do something to them.  And no amount of reasoning is going to change the way they feel, because it's hard-wired in them from the outset.

I know that sounds overdramatic.  It's just something I've realized more and more with the passage of years: that there is a strong correlation between the statement, "My parents smacked my butt when I acted up and it made me the person I am today," and the statement, "Keep the refugees out because they'll take our jobs and murder us in our beds."  And I don't mean the correlation of conservatism, because there are conservatives who don't appear to be terrified and aggressive, but who just want a smaller government and so forth.  There are also liberals who seem to be waging a defensive class war.  Meanwhile I've noticed that attached children really do share their toys better and that people who grew up with lots of affection from their parents seem to be happier as adults.  And the science backs me up on this, as far as it can -- though of course temperament itself is mainly genetic and is probably the largest factor.

But the other thing I've slowly learned, over time, is that there really is a conflict between attachment parenting and closely-spaced childbearing.  I've listened for years on Catholic mothers' forums where people ask over and over again how in the world they can be attached, peaceful parents when they have a lot of kids.  And I've listened to other people say it can't be done, not without losing your own mind, and they should give up the ideal.  Make yourself believe that, when you leave your baby in his crib crying for an hour, it doesn't do him any harm.  But I haven't been convinced by this answer, even while I've failed to find another one.

I still think it's worth trying, even if you're overwhelmed.  I mean, I do and am.  I'm not going to tell myself comforting lies about what kids need, because I know the truth.  If I can't live up to it, I'll just keep trying.  Better to spread myself thin than to deny my kids something they need as they grow.  But I think I'm finally forced to confess, I wouldn't recommend this to others.  The inconvenient truth, the thing people would like to deny, is that children really do need all of you.  What you choose to do with that truth is up to you, but there's no easy no-sacrifice answer.