Polyvagal Informed Parenting

Applying the principles of Polyvagal Theory to parenting is substantially beneficial and empowering. 

The basis for this is that since Polyvagal Theory explains how our physiology responds in response to internal and external cues and stimuli, by embodying this understanding and the related principles in any domain of life, including parenting, we are able to work with our physiology.  As described above, whether or not we choose to acknowledge and understand these processes, they are continuously occurring.  By not embodying these principles we are, effectively, taking the chance that we may react or respond in a skillful and effective fashion.  In contrast, by fully embracing and implementing the polyvagal informed skills and strategies, we provide ourselves the greatest likelihood for performing in our role as humans and parents in the best possible fashion.  In addition these principles apply equally to those around us, including our children.  Recognizing and working with their physiology provides the best opportunity to develop connection with our children and optimize our ability to co-regulate them.

In addition to applying the polyvagal informed practices to ourselves, there are additional considerations in applying these skills and strategies to our parenting. It is important to recognize that just as the resilience of our nervous system is not determined by a lack of dysregulation, the relationships we have, including with our children, is not defined by a lack of conflict or rupture.  Rather, our relationships are better evaluated on the ability to rapidly and effectively repair any ruptures or conflicts which arise.  As we are all human, we will not always respond, react, and behave in the fashion we hope to.  There will be instances, including in our parenting, where we will behave suboptimally.  The recognition that, firstly, we are human and this is not abnormal or unexpected in combination with the acknowledgement that when this occurs, it the ensuing process of repair that is most important and the determinant of the resilience and quality of our relationship can provide substantial freedom and empowerment.

Application of Polyvagal Theory to parenting begins by accepting our physiological state, wherever it may be, as well as that of our child in the present moment.  It is important that this acknowledgement be without judgement or blame.  It is also helpful to recognize that our physiological states, as well as that of our child, can shift and change continuously in response to cues in the internal and external environment.  This makes our, and our child’s, physiological states dynamic in nature.  In addition, we can use the features of our own actions, behaviors, and physiology and that of our child as useful information to determine the current physiological state.  This is also done without criticism or judgement.  For instance, aggressive or attacking behavior should be seen as a reflection of physiological state, indicating that the individual feels under threat, rather than a conscious and deliberate decision.  Specifically, a child who has a tantrum in the grocery store is reflecting a sympathetic physiological state rather than an intent to cause commotion in the public place.  It is important to note that this understanding does not excuse poor behavior, rather it provides a useful explanation for it.

A polyvagal informed perspective to parenting will recognize that children, particularly when young, are not able to effectively and consistently self-regulate. 

Rather they rely upon their caregivers for co-regulation.  Through the process of providing cues of safety, thereby allowing for co-regulation, the child develops over time the ability to self-regulate.  In order to effectively co-regulate, it is important for the caregiver to shift their physiological state towards a ventral vagal predominant state.  This will result in the characteristic features of this physiology, thereby providing cues of safety to the child.  We are not able to project cues of safety and connection if we do not actually feel safe and connected.  It is not possible to fake this feeling.  The question then becomes, particularly in the midst of a challenging situation, for example the public tantrum, how do we shift our physiology to feel safe to be able to co-regulate.

The ability to find cues of safety in the midst of high demand and stressful situations results from two important skills.  The first is the ability to recognize without judgement our own physiological state.  The second is to employ skills and strategies that will shift our physiology in the desired direction.  For instance, during the public tantrum we may recognize that we are shifting into a sympathetic state.  Upon this identification, we can then turn to skills such as breathing, relaxation of facial muscles and posture, use of voice, relaxing our jaw, and finding cues of safety in our internal and external environment to help shift our physiology towards a ventral vagal state.  As we accomplish this, we will be able to co-regulate our child.  These skills are complex and require intentional and deliberate practice in order to develop a level of proficiency.

From the polyvagal informed perspective, it is important to remove cues of uncertainty, risk, and threat to the greatest extent possible from our child’s environment.  Of course, it is not possible to completely remove these potential cues.  For this reason it becomes important to recognize that when a child neurocepts such cues, there will be a predictable physiological shift which will then result in behaviors that can be anticipated.  Maintaining the greatest degree of consistency in parenting is important so that the child is able to predict responses and reactions.  Uncertainty can be a significant cue leading to mobilization towards sympathetic states.  In addition, consequences for behaviors should be carefully considered and chosen so as to avoid introduction of additional cues of uncertainty, risk, and threat.

Continue to follow @Parentsuitcase on Instagram and Pinterest and a special thank you to our collaborative expert content contributor Dr. Davidson MD, MHSC, FRSCS

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Introduction into Polyvagal Theory

Have you ever been stuck in traffic? Has your child ever had a tantrum in public?

We have all been in these situations many times. When these circumstances occur, are there days when you respond in a calm and constructive fashion while at other times become frustrated, aggravated, or felt like giving up? Of course, we have all experienced these feelings and reactions to these situations at one time or another.

Why does this occur?

The situations are the same, or at least very similar, so why might we have such a different responses? The answer to this important question lies in the function of our nervous system. Specifically, the explanation relates to how our nervous system is continuously scanning our internal & external environment for cues of safety and cues or risk or uncertainty. While this may seem complex, an understanding of Polyvagal Theory makes this more accessible than it may appear at first.

The concepts of Polyvagal Theory are becoming more commonly discussed and encountered within all areas of life. While the more frequent discussion of this theory may be relatively recent, it was first described by Stephen Porges, PhD in the mid 1990’s. This theory is evidence-driven and describes how our nervous system, specifically the autonomic component, functions in response to the cues and stimuli we continuously encounter in our internal and external environments. The theory further explains how our nervous system uses this information to direct responses across our entire body, including our thoughts, muscle tension, posture, hearing, voice, breathing, and digestive functioning.

The basis for these widespread effects is our vagus nerve and its connections to many aspects of our physiology. The true power of this theory lies not only in its explanation of how we experience the events in our life, but through the provision of skills and strategies that we can implement to direct our physiology in ways that are most supportive of what we are trying to accomplish in a particular situation.

Polyvagal Theory is based on details of our neurophysiology which are common to all social mammals.

There are specific core principles which are important to understand in order to apply the details of the theory in our lives. These include the physiological states determined by our nervous system, the process of neuroception, the social engagement system, and the concept of our physiological state as an intervening variable. With an understanding of these concepts, it is possible to embody the principles of the theory and improve our lives as well as the lives of those around us.

The physiological states determined through Polyvagal Theory are ventral vagal, sympathetic, and dorsal vagal.

These states are evolutionarily determined with the ventral vagal state being most recent. It is important to understand the characteristics of each state in order to be able to identify our state at any given time and learn to shift our state towards that which we choose.

The ventral vagal state is one in which we are grounded and connected to ourselves and others. Our thinking tends to be more oriented towards curiosity, being open to possibilities, and optimistic. Our muscle tone is relaxed, our jaw and facial features are softened, there is range & prosody in our voice, and our posture is open. Our breathing is deeper and slower, typically in conjunction with a diaphragmatic pattern. There is increased variability in the time between our heartbeats, referred to as heart rate variability. Our heart rate is increased during inhalation and decreases during exhalation, referred to as respiratory sinus arrhythmia. This state is considered as a state of safety and connection, both to ourselves and others. It is within this state that our body is in homeostasis and is able to recover and restore itself.

The sympathetic state is the widely known as the fight or flight response. This occurs in response to a perceived risk or threat. This state is characterized by anxious, angry, or aggressive thoughts. Our muscle tension and jaw tighten. The prosody and pitch of our voice loses its fluctuation. Our posture becomes more closed. Our breathing pattern typically becomes faster, more shallow, and centered in the chest. Heart rate variability is decreased.

The dorsal vagal shutdown state is best described by the response of the body to an overwhelming threat in which we try to conserve as much resource as possible by hiding and, at the extreme, feigning death. Our muscle tone is decreased. Our facial features become flat. Our breathing slows and becomes shallow. Our thoughts are consistent with giving up and hiding.

While each of these physiological states are appropriate and adaptive in certain circumstances, we are best able to express our truest and fullest potential as well as problem solve and perform to our highest capacity in either a ventral vagal state or a blended ventral vagal-sympathetic state. Due to this, the states can be organized in a hierarchy with the ventral vagal state at the top, followed by the sympathetic state, and the dorsal vagal state. It is important to note that we both descend and ascend this hierarchy through each state. In practice, this means that in order to ascend from a dorsal vagal state, we must first reach a sympathetic state, if even only briefly, before reaching a ventral vagal state.

The next foundational principle of Polyvagal Theory is neuroception.

This is the process by which are nervous system essentially scans our internal and external environments to detect cues of either safety and connection or cues of uncertainty, risk, and threat. This process occurs continuously and beneath conscious awareness. On the basis of whether there is a preponderance of cues of safety and connection or uncertainty, risk, and threat our physiology will shift on the hierarchy. If the balance of cues is in favor of safety and connection our body moves towards a ventral vagal state. On the other hand, if the balance is towards uncertainty, risk or threat our physiology moves first towards a sympathetic state and, if there are further cues of risk and threat or the initial threat is not resolved, then into a dorsal vagal state. It is important to emphasize that neuroception occurs whether or not we choose to acknowledge the process and develop skills to shift our states towards our chosen physiology. This process occurs beneath conscious awareness and, as such, it is not our choice to shift towards sympathetic and/or dorsal vagal states and to take on the characteristics of those

states.

The next foundational principle of the theory which will be discussed is the social engagement system.

This describes the connection from our brainstem to the muscles and organs in our face and chest through various cranial nerves. Many of the characteristics of the physiological states described above specifically reference the head and neck region. The resulting changes in facial features, voice, muscle tone, posture, and breathing not only reflect and impact our own physiological state, but also provide cues to those individuals around us. Through the process of neuroception, those individuals will then determine whether or not we are providing cues of safety and connection or cues of uncertainty, risk, and threat. It is through this social engagement system that we are able to influence the physiological state of ourselves and those around us. If we truly feel safe and connected in our body, we are able to project these cues externally through the social engagement system and this will allow those around us to shift their physiology towards a ventral vagal state. This process is termed co-regulation. The ability to shift our own physiology towards a ventral vagal state is termed self-regulation. Typically, it is not possible initially for younger children to self-regulate. Rather their future ability to self-regulate is dependent upon co-regulation from their caregivers when they are young.

The final foundational aspect for consideration is the principle of physiological state as an intervening variable.

Functionally, this corresponds to the understanding that our current physiological state will influence the process of neuroception such that a particular cue may be neurocepted as a cue of safety and connection if we are in a ventral vagal state but may be neurocepted as a cue of uncertainty, risk, or even threat if we are in a sympathetic or dorsal vagal state. This principles informs our everyday experience of noticing different reactions to very similar events, such as the traffic and public tantrum examples, described above.

In response to cues of uncertainty, risk, and threat both internally and externally, we have seen how our physiology can shift towards sympathetic and dorsal vagal states. This process is not in and of itself maladaptive. Rather it is the normal, predictable, and expected response of our nervous system in response to these cues. By extension, the hallmark of a healthy, resilient, and adaptive nervous system is not the lack of dysregulation towards these states. Rather, the defining feature of resilience within our nervous system is our ability to restore stability following periods of dysregulation. In particular, it is our capacity to efficiently and effectively self-regulate.

Follow along to read more about Polyvagal Theory and Parenting in this next blog!

Blog contribution from Darin Davidson MD, MHSC, FRCSC Polyvagal Informed Coaching & Concierge Care

Follow on social media: @ParentSuitcase on Instagram and Pinterest

REFERENCES:

Dana, D. Polyvagal Exercises for Safety and Connection: 50 Client-centered Practices. New York: W.W. Norton & Company; 2020.

Dana, D. Anchored: How to Befriend Your Nervous System Using Polyvagal Theory. Boulder, Colorado: Sounds True, 2021.

Delahooke, M. Brain-Body Parenting: How to Stop Managing Behavior and Start Raising Joyful, Resilient Kids. New York: HarperCollins, 2022.

Porges, SW. Polyvagal Safety: Attachment, Communication, Self-Regulation. New York: W.W. Norton & Company; 2021.

Porges, SW. The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, Self-Regulation. New York: W.W. Norton & Company; 2011.

Porges, SW. Presidential Address, 1994. Orienting in a Defensive World: Mammalian Modifications of our Evolutionary Heritage. A Polyvagal Thoery. Psychophysiol 1995; 32: 301-318.

Parenting & Childhood Illness Prevention

I read an article this morning from WSJ about the the current viral surge that has parents, providers, children, and schools scrambling for solutions. What are some of the various concerns that parents are reporting:

• Lack of paid time off / flexibility to take off for family illness; roughly 104,000 Americans missed work due to child care issues in October, the highest number on record by the Bureau of Labor Statistics since 1994.*

• Lack of backup care

• Concerns about COVID-19

• Missing out on in-person school instruction

Parents have experienced their ample share of challenges and work cancellations over the past 2-3 years as a result of the pandemic. Not only are parents navigating school safety concerns, they are also doing their best to optimize family wellbeing by adopting preventive health measures to ensure that all family members are as healthy as possible. As parents who are already dealing with significant family / work / household stressors, what precautions can we take to help mitigate & prevent the spread of illnesses?

Practicing hand hygiene skills with frequent handwashing at home: 

According to CDC, keeping hands clean with handwashing can help to prevent 1 in 3 diarrheal illnesses and 1 in 5 respiratory illnesses.**

Here are some key opportunities to wash hands**: 

1. Before & after food preparation and eating

2. Washing before & after caring for a friend / loved one that is ill

3. Before & after wound care- cuts, scrapes, or other more involved wound care.

4. After using the restroom and / or changing a soiled diaper

5. After blowing your nose, coughing, or sneezing- this is a great habit to cultivate at home in order to strengthen that practice at school.

6. After touching animals, handling pet food, or animal excrement

7. After handling garbage and waste materials

I have been reading a lot of articles and social media posts on respiratory illnesses lately, in particular respiratory syncytial virus (RSV). RSV typically circulates during colder months and into early spring. Here in the U.S., roughly 58,000-80,000 kiddos <5yr old are hospitalized to due RSV.*** In infants & young kiddos, the following categories are considered higher risk for severe illness from RSV:***

-Infants, especially those <6 months of age, kiddos born prematurely.
-Children <2 years old with chronic lung disease (like asthma), congenital heart conditions
-Children with weakened immune systems
-Children with neuromuscular conditions: the weakened respiratory muscles can make it difficult to clear mucus

Similar to the prevention tips above, practicing optimal hand hygiene plays a big role in mitigating the spread along with staying home when feeling sick, covering coughs / sneezes (along with subsequent handwashing), abstaining from smoking around children, avoiding utensil & cup sharing, etc. RSV can live on outside of the body for several hours, therefore keeping high-contact surfaces clean (i.e. doorknobs, toys, countertops, appliance handles, etc.) can help to decrease viral contamination.

What else contributes to overall optimal health? SLEEP!

Optimizing our sleep hygiene- sleep is a crucial part of our own wellbeing and overall function. Children and adolescents who lack enough sleep are at higher risk for obesity, type 2 diabetes, poor mental health and attention/ behavioral issues.** It can also impact their academic performance due to lack of attention. ‍

The American Academy of Sleep Medicine recommends the following: 

Children ages 6–12 years: 9 - 12 hours per 24 hours

For 13–18 years of age: 8 - 10 hours per 24 hours

What else can we do to optimize our sleep health? Avoiding blue light exposure before bed- everyone has different opinions on the specific amount of time before bed (I personally try to avoid it at least 1 hour before bedtime). Keep you room cool, dark, and quiet like a cave- this is something I learned from Dr. Shelby Harris on Instagram. Some other things we can do before bedtime: read a paperback book, avoid alcohol at least 4 hours before bed, and avoid caffeine roughly 6 hours before bedtime.

‍Staying up-to-date with preventive health measures as advised by your healthcare team. If you have any specific questions on vaccines, please connect with your healthcare team to discuss. If you want more information on immunization schedules per CDC, check out: https://www.cdc.gov/vaccines/schedules/

Eating nutrient-dense foods and healthy options as much as possible. During high holiday season, a lot of our celebrations & gatherings include meal preparation, leftovers, and (most likely) LOTS of sweet treats and desserts. I am not a nutritionist, but I do know that balance is key! Here are some ways to eat healthy while also on a budget: 

Batch you meals and plan your recipes based on seasonal ingredients, budget, and availability. What can you buy that is local, easy to store, and cost-effective? Be creative when making your own recipes and keep it simple. One of my favorite places to search for recipes is Epicurious.

Look at labels: do you notice any words or preservatives that you are unfamiliar with? You can do some investigating and look them up online by searching for reputable sources. You'd be surprised at how many prepared foods & condiments have unfamiliar preservatives, gums, and additives.

Limit added sugars when possible- what other options can you add for sweetness? Berries and other fruits are great alternatives.

Think about fiber intake! Fiber is so important for digestive / bowel health. What can you integrate into family meals? Consider beans, grains (like bulgur, barley, and oat bran), broccoli, carrots, green peas, apples, etc. There are lots of healthy options!

Maintaining some sort of physical activity on a routine basis: (before doing any exercises, please consult your healthcare team to determine what is safe, effective, and advised for you!)

Personally, I prefer to diversify my physical activity in order to keep it fun and the variety allows me to target different muscles groups. Here are some of my favorite exercise activities along with a brief summary of what they entail: 

HIIT workouts: this exercise is a form of interval training which involves quick bursts of high-intensity exercise with intermittent intervals of rest / lower intensity exercise. I tend to integrate at least 5-15 minutes of HIIT exercise into my cardio routines.

Kettlebell workouts: this piece of equipment looks like a bell and varies in heaviness. Integrating kettlebell exercises into your workouts can help to strengthen your core, increase overall strength, and increase power endurance.

Barre workouts: a great way to improve posture and alignment, lean & tone muscles, and to improve balance. This is one of my absolute favorites and it's an exercise routine that I find truly humbling! Barre classes are generally lower dumbbell weights and higher repetitions.

Treadmill: a great one for cardiac health and pretty self-explanatory. You can walk, increase the incline to boost your heart rate, or can vary the speed and intensity as you prefer. I’ve seen a lot of social media posts on the “12-3-30” Walking Treadmill Routine which is described as an effective way to strengthen muscles as well as providing cardiovascular health benefits. As a reminder: before starting any workout, it is important to consult your healthcare provider to see what routines are best suited for you.

Rowing machine: total body workout that also allows you some time to practice meditation as it is (or can be) a repetitive motion activity. If you are looking to obtain a full body workout, it's a nice alternative to using a treadmill or an elliptical and it's great for all fitness levels.

Limiting snack sharing / sharing of drinks if and when possible. 

This can be a tricky one for kids! In order to reduce the spread of illnesses, try to be mindful of snack sharing and discuss the rationale for doing so at home. As mentioned above, continuing to practice regular hand hygiene also helps to mitigate the spread of illnesses.

Staying home when we are sick

This is a BIG one. I know that it can be difficult to miss a work day if either you or your child(ren) is sick. In order to prevent illnesses from spreading, it's important to maintain good hand hygiene and to stay home when you are not feeling well. Check with your employer about their sick leave policies and flexible work options in the event of personal / family illness. CDC has some great resources on how to handle Influenza as an Employee

We can also practice some stress reduction measures in order to keep our stress levels low (which can also benefit our immune systems). This practice looks different for everyone!  

What other ways can you think of to prevent the spread of illnesses?

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All sources are linked & referenced above in order:

https://www.wsj.com/articles/how-sick-is-too-sick-for-school-rsv-flu-and-colds-strain-parents-and-school-nurses-11668999005

https://www.cdc.gov/handwashing/

https://www.cdc.gov/rsv/references.html#factsheet

https://www.cdc.gov/rsv/downloads/RSV-in-Infants-and-Young-Children.pdf

https://www.cdc.gov/flu/prevent/vaccinations.htm

https://www.cdc.gov/diabetes/healthy-eating-budget.html

https://www.prevention.com/fitness/workouts/a39584587/12-3-30-workout/?utm_source=google&utm_medium=cpc&utm_campaign=arb_ga_pre_md_pmx_us_urlx&gclid=CjwKCAiAmuKbBhA2EiwAxQnt70mNPFAKgPJzzD5WRDCBgCcCUl9pSCiZJa-ALu74upSA7c8UoeNf-RoCl3gQAvD_BwE

https://www.cdc.gov/flu/business/stay-home-when-sick.htm

#childhoodillness #familyhealth #familywellness #healthykid #healthyparents #healthykidscommunity #healthyparenting #parentalburnout #childillness #parenthealth #burnout 

Disclaimer: The information on this platform is not intended or implied to be a substitute for personal professional medical advice, diagnosis, or treatment. All platform content including text, graphics, images, and information is for general information purposes only & does not replace clinical consultation with your own doctor/mental health professional.

When a child is diagnosed with cancer: Part I

When a child is diagnosed with cancer, there can be an understandably strong, emotional reaction from parents and family.  There are several ways that this extremely difficult situation can be assisted, including obtaining information, gathering resources, and asking questions.  Part I of this blog provides an overview of these elements to create a foundation for parents and families who may be navigating the challenges and emotions of having a child with cancer.

Childhood cancer may share some aspects with adult cancers, however there are also many notable differences.  There are approximately 10,470 new cases of cancer amongst children younger than 15 each year in the United States.*  These cancers account for numerous types- some are also seen amongst adults and others are specific to, or more frequent in, children.  The majority of instances of cancer amongst children are not related to environmental or lifestyle factors, as is much more frequent in adults.

The diagnosis & management of childhood cancer is typically more specialized than it is amongst adults.  While many forms of cancer in adults are treated in both community and specialty centers, the majority of childhood cancers are treated in specialized pediatric settings.  This leads to increased challenges in access to care amongst families who do not live in proximity to major medical centers, where most pediatric centers are located.  Treatment methods may also differ amongst children in comparison to adults.  In part, this is the result of childhood-specific factors, such as growth.  In order to preserve growth, treatment strategies amongst children may be substantially different than they would be for adults.

Another important difference between childhood and adult cancer is the prognosis.  Amongst all types of cancer in children, the overall 5 year survival is approximately 85%.  This represents an improved prognosis compared to adults.  It is important to consider, however, that this estimated survival is amongst all types of cancer and, unfortunately, there are cancer types that are associated with a lower 5 year survival.  The prognosis is dependent upon the type and stage of the cancer at the time of diagnosis, but typically there is a better survival rate amongst children with cancer than adults.

Parents and caregivers of children diagnosed with cancer are understandably presented with several significant challenges.  There is the initial shock of the diagnosis and obvious concerns for the wellbeing and health of their child / loved one.  In order to support themselves and those around them, there are several aspects that parents can emphasize. 

• They should obtain as much information as possible, both from the treating providers and through their own research.  Understanding as much of the applicable medical information as possible is important in order to make informed treatment decisions as well as help answer questions that the child and other family members may ask. 

• By obtaining relevant and accurate information, anxiety about the diagnosis, treatment, and outcome can be reduced.  It is crucial that parents understand as much as possible about the diagnosis and treatment options. 

• In order to make informed decisions, it is important to understand not only what is recommended by the treating provider, but also other appropriate treatment options.  This may require obtaining a second opinion, which should not be a hesitation.  It is crucial that pediatric specific specialists be involved with treatment planning and provision of as much treatment as possible. 

• Given logistical considerations, it may not be possible for every child to be treated in a pediatric specific center.  In such cases, obtaining recommendations from a pediatric cancer specialist that can be implemented closer to home should be considered.

Please follow along for Part II: Childhood cancer treatment & other considerations

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#parent #childhoodcancer #parentsupport

Disclaimer: The information on this platform is not intended or implied to be a substitute for personal professional medical advice, diagnosis, or treatment. All platform content including text, graphics, images, and information is for general information purposes only & does not replace clinical consultation with your own doctor/mental health professional.

Sources:

*Cancer.org