Q&A: 4 Year Old with Periventricular Leukomalacia (PVL) is Very Fussy

Day2DayParenting Child Development, Special Needs Diagnoses

blockquote_bgMy daughter is 4 years old and was diagnosed at birth with PVL and a Stage 3 Brain Bleed. She was born at 29weeks. She does say words but doesn’t say sentences and she is in special services programs through Rise. She’s really smart. My problem is that she is really fussy and throws fits everyday especially with her dad when he leaves for work. A day doesn’t go by that she’s not throwing fits every evening, but around other people she is a different person. It’s very hard to please her at home unless we have company. We know she is very tired and has a long day. We just need advice on how to get her out of these fussy and crying episodes.

Since you describe your daughter as only having these fussy periods at home and particularly with her father when he goes to work, yet being fine around others, it sounds as if her episodes are behavioral and have perhaps become a learned pattern for her over time. Also, her lack of expressive language makes it difficult for her to express that she is sad or upset when Dad leaves for work. Like all kids, I am sure she would rather that he stay home with her and her acting out may just be her only way to show you this right now. First I would have you examine what your and your husband’s typical reaction is to her crying/fussing? Does she get a lot of extra attention when she cries, does she get held, does Dad delay leaving for work when she fusses?

If so, you could be unknowingly rewarding her for this behavior and thus making it continue or even increase. I would treat this the same as you would separation anxiety in a toddler, which is give advance warning of transitions “Daddy will be leaving for work soon, but he will be back”. Have Dad make a routine of doing the same thing every day, such as paying extra attention to her before he leaves, maybe giving her a “transitional object” of Dad’s like his hat (or anything that reminds her of Dad), but when it is time to leave, say goodbye matter of factly and kiss her goodbye and tell her when he will return.

I would suggest that you start preparing her for Dad’s departure well before Dad actually leaves for work each day. You can use a method that best suits her cognitive and receptive language abilities. For example, you could take photos with your camera of things that happen during her day and make her a photo album book which outlines her day including daily routines like Dad’s departure for work and also when he comes home again. Go over her book with her several times per day, especially an hour or so before Dad leaves to prepare her for this transition. Although it is not easy, try to ignore her fussing and tantrums and try to distract her into an activity or something novel once Dad leaves. Do not allow Dad to prolong leaving when she fusses and both of you remain matter of fact at his departure saying “Daddy will be back”. When he does return from work, this is when you should lavish the attention on her with “See, Daddy ALWAYS comes back home to see you!” and make a fuss over her then so she learns that she gets attention when Dad returns, not when she fusses when he leaves.

You can make her a sticker chart or another reward system as well if she can cognitively understand this and reward her for not fussing when Dad leaves. This site has many free printable behavior charts.

For example, whenever she doesn’t fuss she gets a sticker and if she collects 3 stickers in a week she gets a special prize or treat and then build up to getting a sticker daily. Also since she has single words, but not sentences, work on teaching her “feeling words” such as sad, angry, happy, and even make her picture cards with faces to express her feelings when Dad leaves. Acknowledge her feelings, and say “I know you are mad/sad/upset that Daddy went to work, but Daddy will be back in the morning/after dinner, etc” Encourage her to use words or use the picture cards to tell you how she feels rather than crying, fussing. Since you mention that she is in special services with RISE, I would also speak to her therapist or teacher there since I am sure they know her well and ask for other ideas which may benefit your family to help you at home. You can also find many articles if you do a Google search for “separation anxiety” in children. Also check your local library or bookstore for children’s books which address separation or feelings that you can read to her.

Day2DayParentingQ&A: 4 Year Old with Periventricular Leukomalacia (PVL) is Very Fussy