OFFICE VISIT = AN ANXIETY ATTACK = MENTAL MODEL

When infants and toddlers come to the office for "well" infant/toddler visits, there is a sequence of events which transpire. The baby/toddler is taken into or enters the exam room, their clothes are removed, they are taken to the scale to be weighed, they are placed on "the table", the doctor comes and "gets into their space" (without asking) and the nurse comes in and "stabs" them.

Parents are often surprised and embarrassed by the behavior of their child in this situation. And it seems to only escalate with each visit even though the child is getting older and "should be getting used to it". I have created a new Spanish colloquialism which might apply to this situation: Dola? (which is a contraction of duh + ola and means duh, hello!)

Actually, the neurobiology/neuropsychiatry researchers have in fact figured out exactly why the infant/toddler brain does what we see. A lot of this information is in a book listed on the Sea View web site entitled "Parenting From The Inside Out" written by Daniel Siegel (UCLA, sorry USC people) and Mary Hartzell. The following is a quotation from an article by Dr. Siegel and helps us to understand what is going on in our infant/toddler's mind and the behavior which follows:

"Memory is the way in which past experience is encoded in the brain and shapes present and future functioning (McClelland, 1998; Milner, Squire, & Kandel, 1998). The processes of memory and those of development in fact are closely aligned. For the first year of life, the infant has available an “implicit” form of memory that includes emotional, behavioral, perceptual, and perhaps bodily (somatosensory) forms of memory. Implicit memory also includes the generalizations of repeated experiences, called “mental models” or schema (Johnson-Laird, 1983). The way that the brain readies itself for retrieval of certain memories in response to specific cues is also a part of implicit memory and is called “priming” (Schacter&Buckner,1998). When implicit memories are activated, they do not have an internal sensation that something is being recalled. They merely influence our emotions, behaviors, or perceptions directly, in the here and now, without our awareness of their connection to some experience from the past."

It is no surprise that we don't know why our infant/toddler is behaving this way because she doesn't know either. But she has created a "mental model" and that model ends with getting the shots (pain). And the obvious reaction to knowing the end of the sequence is to call on the "fight or flight" response and that is exactly what they do.

Now, instead of feeling anxious, embarrassed or irritated, we can all just say "Dola?"

More about Dr. Siegel:

http://www.latimes.com/features/la-mag-july122009-taste-siegel,0,1272981.story

From the Los Angeles Times

Tastemakers

Daniel Siegel, MD

by Nancie Clare

July 12, 2009

When Siegel was a med student, he was actively discouraged from finding out what patients were thinking. Now in his current practice as a clinical psychiatrist, executive director of Mindsight and codirector of the Mindful Awareness Research Center at UCLA, it’s the mind he is most interested in—specifically how it can be channeled to help the whole body. One of the core practices of “mindsight” is concentrating on the breath. “Mindsight can increase one’s ability to perceive the world,” he says. Siegel created practical applications from his research: He has lectured to school superintendents, and educators confirm mindsight’s effectiveness as a foundation for social and emotional intelligence. Even the world’s spiritual leaders are interested—he met with Pope John Paul II and the Dalai Lama. And what of Freud? Siegel thinks he would approve—heartily.