Managing Transitions Part I


This blog posting is a continuation of my writing on helping children make transitions – of all kinds. I am writing this with the awareness that very young children are much easier to help in this way even though it may not seem so at the time. In fact, it is possible that helping very young children to manage transitions could make this challenge easier for them later in childhood or even in adulthood, but this is not certain. It is always our wish that we could prevent future problems by addressing them early on, but that is not always the case. For that reason, I will also focus on helping older children and adolescents manage transitions. Since I am approaching these tasks as collaborative activities between child and caregiver, I will use a short cut and refer to C-CG as a unit.

As I write this I am also aware that the whole subject of making transitions cuts across many categories of concern for parents and other caregivers, as I mentioned in my previous posting. That is, for example, issues of regulation, compliance, motivation, learning, organization, emotion and mood, sensory, and probably many more. Here is an illustration of what I mean. In order to make the transition from home to school in the morning, the C-CG must manage the transition from sleep to wake (involving the organization of state and the regulatory challenges involved in the shifting from one physiological state to another), then the C-CG must organize the sequence of small tasks involved in preparing for the day – bathroom tasks, dressing, eating breakfast, etc. I use the word “organizing” consciously because putting all the small actions together is part of the challenge. I remember reading an article somewhere about a study in which subjects were tracked as they went through their day in a restricted space to demonstrate all the redundant movements and retraced steps they took (back to the refrigerator to get the milk after you had just gotten the butter out). The task of getting dressed – finding and choosing what you are going to wear, and putting on the clothing – may be complicated by varying degrees of discomfort if sensory hypersensitivity is a problem. Eating breakfast may be complicated by lack of appetite or (again) sensory sensitivities. Leaving the house is affected by feelings about leaving home and family and anxieties about what one will face in the challenging world of school.

All of these aspects of transition can be facilitated by three aids – 1) attention to regulation; 2) knowledge of specific strengths and vulnerabilities of the particular C-CG pair; and 3) routines and rituals. Each of these aids must be accompanied by the girl scout (it is probably in the boy scouts, too) motto of “Be Prepared”! Let’s go over them one by one.

1) Attention to regulation is extremely important for both members of the C-CG pair (in fact for the whole family or group). That means thinking ahead (Be Prepared) so that, for example, in managing the morning transitions, you can assure as much as possible that the C-CG is well rested. It means (Be Prepared) that adequate time, or even extra time, has been allocated for the task at hand. It also means that (again Be Prepared) that complications (someone else in the bathroom, another child interrupting with their own demands) are anticipated. It might mean that the CG has already had his/her cup of coffee. It might also mean that the CG is thinking about (has in mind) talking with his/her partner or a friend for support later in the morning.

2) Knowledge of the specific strengths and vulnerabilities of the particular C-CG pair is also crucial. The best way to illustrate this point is through examples. In fact, I have decided to try something new and to publish one example at a time, inviting my readers to post comments on the subject. What I would like you, as readers, to consider are the specific strengths and vulnerabilities of the C-CG pair I am writing about. Here is the first C-CG pair, of course, embedded in family and community environment:
a. Morning Transition:
Jamie is a smart, engaging Caucasian 3-year old boy who lives with his mother and father and his 1-year old sister in a large apartment downtown. His father has a job that requires him to travel and be away from home on average several days a month, and he often comes home from work late at night after Jamie is in bed and leaves for work again before Jamie wakes up. His mother left her professional job when her second child was born and they moved to Boston for a promotion in her husband’s company; she considers her primary role to be a mother. It was difficult for her when she perceived her first precious child as irritable and difficult to soothe, because she worried that she was doing something wrong and reading his cues incorrectly, but the pediatrician assured her that Jamie would grow out of it.
Transitions were a particular problem for the family. Bedtime was complicated because often Jamie would stay awake late in order to spend even a little time with his father after he came home from the office. Then when he would fuss about going to bed his father was reluctant to allow a negative exchange to spoil the good time they had together, so two goodnight books would turn into three, and three into four. The next morning it was very hard for his mother to get Jamie up to go to the preschool he attended in the mornings.

The worst problem for his mother is getting him up and ready in the morning – even when he has no school, but especially if there is a time constraint such as getting to school on time. His mother, fearful that the teacher would judge her for bringing him to school late, would focus all her attention on getting him out of the house and into the classroom. She would brush his teeth (usually not without a fight), dress him, and bring an energy bar with them for him to eat as breakfast in the car. Sometimes she even stopped and bought him a doughnut on the way, to sweeten the ride. She was often reduced to screaming at him when he stubbornly refused to cooperate with the simplest task, such as let her put his arm through the sleeve of his jacket. He would scream back at her. When this happened, she would glance with guilt at the 1-year old in the car seat and wonder what bad effect these screaming matches would have on her.

Leaving Jamie at school was also a challenge, since he would often cling and cry when it was time for her to leave. At first she would stay and try to help him get settled into play, but sometimes her daughter would start to fuss, and she concluded that the length of time she stayed didn’t seem to affect Jamie’s distress at her leaving. She felt awful leaving him there, crying. After that, his mother had barely finished the food shopping and other errands before it was time to pick up Jamie at school. She occasionally talked on the phone to her best friend, who lived in another city, but as the problems with Jamie grew, she started to avoid the other mothers at drop off and pick up time.

Please comment by suggesting ideas for what the particular strengths and weakness of the dyad of Jamie and his mother.

7 thoughts on “Managing Transitions Part I

  1. Richard Honigman, M.D., Pediatrician

    Sitting in my office waiting to transition from one patient to another I read the blog post and the first thing that popped into my head was if this is preschool and there are many options for preschool (not withstanding zip codes), why cant the parents look into a program for the 3 year old that starts later in the day (afternoon rather than morning) so that the issues of sleep or lack of may not play as much of a role in Jamie’s poor transitioning.
    It appears that Jamie’s clock from wanting to be with his father (and vice versa) is not in sync with the demands of preschool and then adds a big burden to the mother’s attempts to manage Jamie, her other child and the rest of the day.

    So perhaps a weakness of the dyad is the mother seeing a lack of alternatives

    My transition is calling and have to see next patient

  2. Claudia Gold

    In reading this story, that is an all too common one, I see a child who had difficulties with state regulation from birth, as manifest by what his mother describes as “irritability.” His mother was attuned to this quality, but, as is also all too common, her concerns were not validated and she did not get help. Instead she was told he would “grow out of it.” Now as a three-year-old this same quality is manifesting as inflexibility. The situation is made worse by her social isolation and stress of parenting two young children with little help. The constant battles with her son escalate the negative affect in the relationship and lead to a downward spiral of mutual dysregulation.

    One weakness is this quality Jamie has had since birth. Some would call it temperament, but I find that word to be all too often used in a judgmental way. I would simply call it “biological vulnerability” since he was born with it. A strength is his mother’s recognition of this quality. Now that this dyad has functioned in a state of mutual dysregulation for three years, they will need to learn a new way of relating that helps Jamie to manage this vulnerability.

  3. Alex

    I agree with all your points. In situations like this a problematic interactive patterns begins early on and if those who are supporting the caregivers don’t do their job well – listen and try to imagine their experience – the developmental path moves more and more off track.

  4. Alex

    This is a practical and thoughtful first line approach. I agree that the mother feels trapped and can’t see alternatives. Her partner is not available to her and neither are the pediatrician and (because of her shame and self-isolation) the teachers.

  5. Jillian Lush

    I am so excited to see the routines that mom and dad have set up. It is such a great place of intervention to see the routine of reading at bedtime with dad. Can this transition start earlier? Can mom and J. begin to prepare for dads arrival with jammies and bath time and book selection, so they can read 3, 4, 5 books together?
    I also notice that the morning routine EXISTS!!!! Though there is struggle, mom has a pattern established with J. that can be tweaked for mutual regulation – perhaps even imbedded into the nighttime routine? (picking out morning clothes, putting toothpaste on the brush for morning, packing bfast snack, etc.)

    I am MOST concerned that mom seems to be loosing social support and here, I wish the school could scaffold her experience. Other parents are feeling the same thing. How nice it would be for her if her experience could be validated by a peer.

  6. Alex

    I agree that it is important to support the relationship between the mother and the school. That is one of the main reasons I asked for comments – so that teachers could “imagine the minds” of parents better and parents could “imagine the minds” of teachers better.

  7. Ginger Gregory

    These are thoughtful comments. There are many strengths here for Jamie and his family. He has an attentive mother who acknowledges his vulnerabilities and a father who enjoys spending time with him, as well as a 1 year old sister whose presence keeps the family from focusing only on his needs and provides some level of balance for the family dynamics.
    Jillian offers great suggestions for tweaking the daily routines that are already present. Some additional thoughts… I sometimes help families make a short photo book of their child’s daily routines, as a way to help develop routines, build understanding of sequences, predict will may happen next, etc. Since Jamie likes books and his mother probably has a smartphone with a camera, perhaps they could create a short book of several of the routines of Jamie’s day each day that he could “read” to his dad at night. This might help him become more inspired to be positively engaged in his morning routines (a photo of him brushing his teeth, helping to put on his shirt, saying goodbye to his mom at school, etc.).
    I hope his mother can ask the teachers for a parent-teacher conference. She could focus on his strengths, ask what they do at school to help him through the transitions of the day, and share what she does at home to help him with daily transitions and also with unexpected changes. It could become a collaborative sharing of ideas on Jamie’s behalf.

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