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Letters from Maine

To the limit

Publish date: July 5, 2017

Do you believe that children whose parents can make and enforce rules are more likely to thrive than those children whose parents are hesitant to set limits? If you don’t see limit setting as a critical function of parenting, you and I are not only marching to different drummers, we aren’t even in the same parade.

You may be tempted to write me off as just another old school ranter because I believe that limit setting is one of the cornerstones of parenting. But, let’s look at some of the evidence. There are several studies demonstrating that children whose parents set bedtimes get more sleep. One recent survey also found that teenagers who got more sleep as a result of enforced bedtimes functioned better in school (Sleep. 2011 Jun 1;34[6]:797-800).

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As reported in the June 2017 Pediatric News, Mary Lauren Neel, MD, a fellow in neonatal perinatal medicine at Vanderbilt University, Nashville, Tenn., has found that children of parents who were permissive “were more likely to have atypical sensory adaptation at age 1 year and increased behavior difficulties at 2 years” than were those whose parents had an authoritative or authoritarian style (“Parenting style linked to atypical toddler sensory adaption” by Tara Haelle). In this unpublished study, children of permissive parents were 2.6 times more likely to exhibit atypical sensory adaptation, were more than twice as likely to have internalizing behavior at age 2 years, and were three times more likely to have externalizing behaviors by age 3 years.

An important question is whether permissive parenting is a problem that warrants our concern as pediatricians. We always are on alert for the red flags of abusive parenting, and, obviously, failure to intervene in cases of abuse can be disastrous. However, if we can believe the results from the studies that have already been completed, it seems pretty clear that permissive parenting can spawn behavioral problems, sleep problems, and the myriad of downstream effects that can result from sleep deprivation. And I haven’t even touched on the possible relationship between permissive parenting and the obesity epidemic.

If we still consider ourselves the preventive medicine specialists, shouldn’t pediatricians and family medicine physicians be more invested in minimizing the unhealthy consequences of permissive parenting? If we can agree on a firm “Yes!” the next question is, When and how should we address the issue?

A more nuanced discussion can be the germ of a future Letters from Maine, but the short answer is that we need to sound as nonjudgmental as possible as we present our case for limit setting. We need to start early before the die is cast, and we should be better about publicizing our supporting evidence. Setting a bedtime can begin in the first 6 months of life. Helping parents learn to say, “No, we aren’t going to feed you only what you like to eat!” can start as an infant makes what can be an unsettling transition to solid food.

Dr. William G. Wilkoff

Our message needs to be that not only is it okay to say “No!” but that, when done correctly, it is the healthy thing to do.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.”

To the limit

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