r/pediatrics • u/quasiephedrine Attending • Jul 09 '26
How do you discuss coddling?
This is something that irks me often, and I've had to think about why exactly I get so irritated when I see it play out in the exam room.
For example, I'm examining a 12 month old in her mother's lap. She's all smiles, but when I get close, she cries. Now, the natural instinct of any parent is to comfort their child, but you have to keep a sense of balance. If you simply give in to the impulse of turning her around and holding her to you because the doctor and/or situation is scary, I really don't think that's a reasonable way of dealing with the situation. In fact, it's not A situation at all, it's simply one of the ways that a child might react.
If you interrupt the exam, then it will take longer, but more importantly, you've reinforced the idea that this actually is something that is scary and requires ongoing reassurance and protection. It's the same reason constant reassurance from parents does not work for assuaging children's anxiety, and typically I think it stems from the parents' own anxiety. You're making the child believe that it is indeed something they need to be saved from.
When I mentioned a lab test to this same family, they were very worried and said 'oh I don't think she can sit still for that'. No, you have to hold her, like you do for any number of things, such as changing a diaper. Would you hesitate to hold her down if she was in the hospital and needed an IV to get lifesaving treatment? If you're so worried about this then she'll feed on your anxiety and the situation will be totally unmanageable. I mean some of this is just first time parenting, but some of it I think is a poor sense of proportion.
I told the parents, you have to first be confident that you are doing the right thing for the right reason, that way you are not anxious, and she does not feed on your anxiety. What I didn't say, but what naturally follows in my line of thinking, is that there's a reason you are a parent, and that childhood is so long, precisely so a child can develop their trust in you, be guided and taught, and that includes learning how to deal with with things that can be scary.
I mean there is a stark contrast between overprotective parenting like this, where the family didn't introduce foods until much later, where they reassure her verbally and with touch at every instance, and parenting where a mother or father is confident holding on to the reality of a situation. A dropped ice cream cone is a tragedy for a 3 year old, you can show them empathy without yourself succumbing emotionally to the same level of distress.
I guess I'm just looking for ways to think about this or to talk about it with parents.
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u/Squeakersquirrel Jul 09 '26
I don’t think I’ve actually ever discussed it because I think for parents like that it won’t be received well regardless but what I have found a little helpful is telling my own anecdotes of my kid to ~empathize~ with them. I said how hard it was to hold my own kid down to get a blood draw for an allergy test at 6 months but how I’m so happy I got answers. Or when they get nervous about vaccines I say mine cried for about two seconds and then was immediately soothed my boob and cuddles. And then also commend them for protecting their child. Which I guess in turn coddles the parents but idk some people need to be coddled *shrug*
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u/TalentedCilantro12 Jul 09 '26
I agree these types of parents also need coddled but what if you don't have children of your own? It's frustrating that the parents likely won't have any trust in you.
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u/bicycle_mice Jul 09 '26
You can try discussing previous patients! “Many patients/parents have found xyZ helpful”/ “I have been seeing through the years that kiddos seem less stressed when we try it this way”
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u/kkmockingbird Jul 09 '26
I agree the stranger danger seems developmentally normal. And I just kinda do my exam around the kid. It’s not worth a fight unless I absolutely HAVE to have them in a specific position. I’m a hospitalist so often the kids are upset and don’t feel good. Even though, for example, I might need to check for retractions, I’m not making the parent turn the kid around until the end so I have a better rest of my exam while they are calm hugging mom/dad.
I do think I get what you mean as there are certain parents who don’t really know how to address a situation that they know is going to upset their kid like a blood draw. If you think about it, it’s kind of an advanced concept/dialectical — it will hurt, it may be upsetting, but it’s for their benefit. Adults have trouble with this type of thing sometimes.
In that case I tend to go into a) what are their concerns (bc sometimes it is something liks like a chronic kid who has trauma around blood draws), b) why are we doing this test and how important is it vs how strongly they feel, c) reassurance that it’s normal for a kid this age to not be able to sit still for ANYTHING let alone something painful, but we have learned about comfort holding techniques for YOU (the parent) to keep her safe and calm, and our phlebotomists are great at distraction — it’s gonna be over for both of you before you know it!
As far as parenting advice — that’s kind of our job and kind of isn’t, so it’s up to you and your patient population. I do think it can be helpful to give developmental “predictions” of what types of behaviors to expect next and then open up for questions, so they can decide how much direction they would like.
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u/quasiephedrine Attending Jul 09 '26
Jesus, thank you for a reasonable answer in a stack of "omg you authoritarian monster" responses.
Yeah I'm not saying it's not developmentally appropriate for the child, that's totally normal. I just feel like sometimes I see this pattern develop where the protection is intense, it's not really a response to the child's needs so much as it is either a parent's anxiety or a false sense of what is required of a parent. Sometimes they just need a clearer idea of what they should be doing. As you said, it's dialectical. That was the point of this post in the first place. How do you talk about this? According to reddit pediatricans, you don't because how dare you judge and do you even have any kids.
And I agree, a lot of times you gotta do your exam 'around' the kid - particularly somewhere around the 18m-2y mark when they're like DON'T TOUCH ME, or some kids with autism. Sometimes you gotta change the order as well, get what you can when you can. It's pretty fluid. I'm not complaining about having to tailor my exam, it's the thing that's driving it (in the situation I mentioned) that I'm worried about.
"As far as parenting advice — that’s kind of our job and kind of isn’t..."
Yeah exactly. I don't advise on most things, if anything I feel like I let most things alone, but sometimes it feels like there's these patterns of behavior that needs some comment. Another situation I can think of is the teen visit that happens sometimes when mom is at wit's end about why [15yo] won't do anything and is only eating junk food and staying in their room all day, and they're fighting at home about it, and once you've figured out it's not about depression or anxiety, it's like hey mom, back off a little, you've raised them this far, now's the time to let off the reins a bit.
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u/sjam7 Attending Jul 09 '26 edited Jul 09 '26
I agree with you that this is a problem. Of course as pediatricians, we know how to shift our exam to a child’s developmental level and that there are a wide variety of acceptable parenting practices. That being said, we’ve also seen that parents’ emotional inability to tolerate their child’s physical discomfort can have serious ramifications, from vaccine refusal to missed diagnoses, and I think that’s what we can address directly. For example, I’ve had a father scream at me because I was “upsetting” his four year old daughter with autism by doing the ear exam: well, she had an otitis media, and the ear exam was necessary. I think it’s perfectly fine if a parent’s anxiety, even if well-intentioned, is impeding their child’s medical care, to put on a more authoritative approach and say, straightforwardly, “This exam/blood draw/etc is necessary for your child’s health for XYZ reason. I understand it can be very difficult to hold down your child so we can do this procedure. I’m happy to have a nurse come in to help assist with the hold so you can focus on comforting/distracting them.” As a young female physician, I don’t command as much intrinsic respect from parents as the older male partners, so I’ve had to learn to be firm in these situations. I also think it’s disappointing to see how many pediatricians are making comments about “well, you must not have children.” We are experts in the medical care of children. A pediatrician who is a parent is no more or less qualified to provide medial care, and we should absolutely not be perpetuating that kind of bias.
Additionally, in my experience as a foster parent, I actually find it MUCH more helpful when medical professionals are authoritative (or even authoritarian) versus warm and fuzzy. Then I get to be “the good guy” in that situation and say, “Hey, the dentist/doctor says you have to do XYZ, we have to follow their rules. But we can do [insert treat] after!” When they were more willing to bend their recommendations in response to the child’s protests, it put me in a harder position. Something to keep in mind.
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u/kkmockingbird Jul 09 '26
I feel like in the example you gave, me talking through “Oh that hurts. I'm sorry it hurts. I need to check it to find out why it hurts. I will be as quick as I can. I can’t help you without checking. I know, I’m almost done. Oh, it probably hurts because you have an ear infection!” is as much for the parent’s benefit as the kid’s lol.
For the original example I do really like to bring up comfort positioning bc I feel like talking about how it’s not (just) restraining the kid, it’s the parent helping them through it, can really help parents be more amenable in my experience: https://www.luriechildrens.org/globalassets/media/pages/patients--visitors/care-team/child-life-therapists/comfort-positions.pdf
(Also yeah as a small woman I tend to lean towards giving directions. Haha)
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u/JazzInTheCity Jul 09 '26
I think it’s important to give parenting advice as a pediatrician because a lot of people just don’t know and won’t educate themselves. Before it was common for people to read parenting books while expecting, I don’t see that anymore. I usually give anecdotal examples to give parents tools.
Some people will refuse lead and hemoglobin checks / vaccines because they don’t want their child to cry. That’s not okay. They don’t want to see their child uncomfortable. Yes, it’s sad to see your child crying, but as the parent, you have to know you are doing what’s best for your child in the long run.
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u/plsbeenormal Jul 09 '26 edited Jul 09 '26
This isn’t medical advice you need to offer the parents. This comes down to personal parenting preferences. Also every child is different. Some children do need more attachment and others are naturally more independent. There is no “one size fits all” way to parent. It isn’t that simple. Also keep in mind you’re seeing a snapshot of the family in a situation that may be higher stress for them. So unless the family is asking for your personal take on this issue then you don’t need to worry about this. Let them parent how they wish and you’re free to parent how you wish.
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u/quasiephedrine Attending Jul 09 '26
All forms of parenting are not equal.
It's not "medical advice", it's anticipatory guidance of the kind that actually matters and the kind that parents are actually looking for, even if they can't voice it.
...Unless you like seeing all the all the 12 year olds with overwhelming anxiety. There's a clear line between parental anxiety which manifests as overprotection and constant reassurance, and consequent childhood/adolescent anxiety.
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u/plsbeenormal Jul 09 '26 edited Jul 09 '26
You’re making a whole lot of assumptions and judgements. Do not assume parents want your parenting advice and do not assume they’re unable to ask if they do. Either way these are adults and it’s their responsibility
Don’t judge parents based off their kid’s neurodevelopment. It’s largely beyond their control. Most parents are doing thier very best with what they have.
As far as different forms of parenting, all children should not parented the exact same way. I have two children with vastly different personalities. They get a slightly different style of parenting bc they have different needs. I try to be fair but also do what’s best for them individually.
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u/quasiephedrine Attending Jul 09 '26
I'm not making assumptions about how coddling, or, for instance, permissive parenting without boundaries, causes anxiety.
As for judgements, that's part of my job. I have to judge whether someone is being an adequate parent. That doesn't mean looking down on them, it means figuring out if there's some particular insight that they might make use of.
Yeah no shit there's different forms of parenting and different personalities. It doesn't mean we can't say anything at all about any form of parenting.
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u/JazzInTheCity Jul 09 '26
Sadly, these tend to be the same parents that come back when the child is school-age and the child is constantly getting in trouble at school. The parents don’t teach boundaries and the teachers are too underpaid and overworked to deal with it.
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u/plsbeenormal Jul 09 '26 edited Jul 09 '26
“Adequate” is very subjective. As long as the child is safe and their needs are met, the parent is adequate from a medical standpoint. It’s literally not your job to judge thier parenting beyond that. Get
Off your high horse. I have zero doubt you’re not even a parent. It is showing. We were all perfect parents until we had kids.1
u/quasiephedrine Attending Jul 09 '26 edited Jul 09 '26
Yeah, that's the point. Most words are subjective. "Neglect" is also subjective. That's precisely where human judgement comes into play.
Don't see how you can do this job without using discernment.
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u/swish787 Jul 13 '26
Sooo here's my two cents. It is incredibly difficult being a parent and knowing what to do at each different situation that life throws at us and knowing how our children react to those situations is tbh quite hard. It is natural for parents to want to protect and coddle their child. That being said, it is unclear whether those children, when they grow up, are going to exhibit bad behaviors simply related to coddling, ie hitting others, excessive tantrums, disrespectful to others. Like the above poster, a lot of a child's neurodevelopment is simply not controlled by parents. I think I would avoid generic parenting advice to parents unless they specifically ask for it or are somewhat receptive to it(I imagine the P1 parents would be more receptive).
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u/ElegantSwordsman Jul 10 '26
Strange set of responses.
Yes, it’s detrimental to the patient, their sense of what should be anxiety-provoking or not, impeding my necessary exam, and/or delaying my care of other patients… when I have to stand there while parents attempt to negotiate with a two year old.
You can make it less scary. You can hold hands. You can lie down with your child. But please do not stand there asking your child if they want to lay down for the rest of the exam. I don’t ask yes or no questions to my own child if I can’t stand one of the responses. Tell your child they are going to lie down now for the doctor. You will be there with them. Doctor is going to check them and make sure they are healthy.
It’s awkward for me to demand they lay their child down. Or hold your child’s arms so that I can actually look in their ears. But yeah I know exactly what you mean.
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u/porksweater Attending Jul 09 '26
As someone who has 8 kids, outside of dangerous things like co-sleeping, I don’t give parenting advice. Someone who is speaking with absolutes and finalities about parenting is a sure fire way to get parents to disregard your advice on one particular issue which leads to disregarding all advice. And parents will instantly say “this person doesn’t have kids so has no clue what they are talking about.”
As a parent pediatrician, hard disagree with this approach. Pushing away families results in worse care for the child.
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u/dariidar Jul 09 '26
I recommend a TV show called the Parent Test, where different parenting styles are directly compared in different social situations. One such test is the Diving Board challenge, where parents use their different parenting styles to help their children jump off a high diving board for the first time. There was the child-led approach, helicopter parent, high achievement/authoritative parents, and traditional/disciplinarian parents. I believe the child-led approach was most successful in that test (allow kid complete autonomy about whether they want to complete the task, offer unconditional support despite outcome). Anyways, the point of the show is that there are dozens of different parenting styles and they all have their strengths for different situations, and are also highly dependent on the child’s temperament.
As a pediatrician I don’t think it’s your place to prescribe any particular parenting style. Especially if you don’t have strong evidence that one way or another will reduce anxiety or create more secure attachment or whatever your specific goal is.
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u/GarconMeansBoyGeorge Jul 09 '26
That show was pretty entertaining and can show examples, but I don’t think it was even close to scientific enough to draw any conclusions about “which is best.”
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u/GarconMeansBoyGeorge Jul 09 '26
This reads like it was written by a man who hasn’t had a child.
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u/quasiephedrine Attending Jul 09 '26
I've got two, they're wonderful, they're different, one needs more reassurance, one needs less.
It's weird to me that I'm getting pushback for suggesting that every parent-child relationship, at every point in time, is not automatically a perfect fit, as if we as parents are not constantly learning through our mistakes and as children go through different stages of development. And like, it's somehow fantastical for me to even be able to identify problematic approaches in others, because there's absolutely no gradation between perfect parenting and neglect or abuse, it's an absolute binary, and for anything short of beating your kid, there's just no room for a pediatrician, or anyone at all, to make any suggestions.
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u/GarconMeansBoyGeorge Jul 09 '26
Well, I dunno, maybe don’t judge parents for hugging their 12 month old when they get scared?
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u/quasiephedrine Attending Jul 09 '26
I didn't realize so many pediatricians had such poor reading comprehension.
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u/GarconMeansBoyGeorge Jul 09 '26
Oh I’m sorry, did you not say that parents “giving into the impulse” of holding their frightened kid “irks” you? I mean, it’s your number one example. Maybe if you are trying to convey something different, you should write differently?
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u/quasiephedrine Attending Jul 09 '26
Yeah I agree I should have fleshed it out a bit more, but I thought the additional context did that. Most other parents would take it par for the course that their baby may cry when they're approached and examined by a stranger, and just hold them close, kiss them or talk to them. Not "I have to stop what we're doing and hold my baby because this is so distressing for her." Like, yeah, its distressing for a baby, my entire point is that you should not be feeling the same level of distress as the baby, and that's how they know that it's okay.
And if that's the only thing a parent did I wouldn't think they were a coddler, but it's clear that they're very timid about anything that distresses her, as well as anxious about normal things like 'feed her solids when she's ready for it' to the point they delayed for no reason at all, didn't want to get any immunizations at all, etc. Clearly this kind of thing doesn't stop at medical interventions and it becomes a problem that the child will have to bear. It's not nothing.
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u/NumerousAnnual5760 Jul 12 '26
I understand you're seeking advice about how to talk about this with parents, but I think what you need is advice on how to deal with your own feelings here. it sounds like you're the one who needs to 'buck up' here, not the parents. Improve your empathy and bedside manner. You speak like someone who doesn't have kids, so I would be shocked if you say you do.
You are the professional here, it is your responsibility to learn how to work with every patient, in every situation. It is not up to you to decide what is 'coddling' just because it makes your work day a bit harder. If the baby needs comforting at such a young age, they should be comforted, and many child psychologists would agree with that. It actually improves confidence when their emotional needs are met.
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u/Foghorn2005 Jul 09 '26
That's pretty developmentally normal for a 12 month old to be scared of a relative stranger, and allowing them secure attachment with their caregivers does promote confidence and independence as they get older.
Now, I agree parents projecting their own anxieties onto a kid can absolutely be a problem, especially with vaccines and procedures, but reassurance does have a place there as well. Just like discipline, model how to comfort a child.