This is the 69^th article written by the Pediatric Group, P.A. for Princeton Online

Upon starting to read this article, you may ask, " Why this topic?" and "Why these authors?" The answer to the second question may seem self-evident, since we, as pediatricians, spend a lot of time and energy reading about and advising parents about raising their children. Only in recent years has the medical community included this and other behavioral topics in the curriculum for new doctors. Over the years of practice we have accumulated a wealth of knowledge about what works and what does not work for parents all depending on the personalities and lifestyles of the parents and the child(ren). No unique approach works reliably for every family. Our views are certainly colored by our own child-rearing experience. Just as it was for us early in our parenting and doctoring careers, you will find that learning parenting is an experiential process.

The answer to the first question is rooted in our societal pattern. A century ago, families grew up in their parents' home and stayed there, inheriting the home and all of its history as their own abode. As society became increasingly mobile, the advice and guidance of parents' parents became progressively less available. As well, the parenting techniques and attitudes that worked for our parents may no longer be appropriate, as society's demands and expectations have changed and we have learned more nuances about child development. We all carry in our minds the effects of our parents' techniques as we grew up, deciding to use or not use certain approaches depending on how they made us feel when we were the subjects of those techniques. Our own life experiences and expectations add to the palette of colors that we use to paint the portrait of what we idealize in a parent. Unfortunately, until we gain the experience needed to verify our parenting techniques, we can only guess whether or not those techniques will be successful. Our second, third and fourth children benefit from the first child having taught us what techniques work in our own family. Although no two children are exactly alike, our general framework for parenting is solidified as we navigate through the first child's developmental stages.

In recent years, the media has reported episodes of horrific violence perpetrated by some adolescents against their peers and family. We wonder whether this behavior is a result of innate personality or the ineffective parenting they experienced. We and others1 believe that, although there may certainly be innate factors playing a role, parenting has a huge influence on a child's behavior. We fervently hope that the information provided in this and the following articles will assist parents in their quest to raise their children in the best way possible. This article is the first in a series that will explore various facets of parenting, from philosophy to practical suggestions.

Biologically, any of us can be a parent. Procreating is a straightforward biological function that is instinctive in all species. Many species reproduce for the sake of self-perpetuation. Our species has been so successful in this regard that we worry about the worldwide supply of food and living space for all of us. Some species leave their offspring at an early age to fend for themselves. Others display what we term "social behavior" in that they stay with their progeny until the age of self-sufficiency. It is this social behavior, or caring, that distinguishes our species from others. The conclusion that there is a worthwhile purpose for procreation is inescapable. It follows that we must do our utmost to achieve the highest level of "good parenting" to satisfy this purpose.

Some of our contemporaries say they would never want to have a child. Although they may be missing out on one of the most rewarding and challenging experiences known to humans, we applaud their recognition that their chosen lifestyle would not allow them to be successful parents. To be a good parent, the first requisite is that a person wants to be a parent. Obviously, making this choice requires forethought. Although the discussion of birth control techniques is beyond the scope of this article, it is clearly an important discussion in the scope of desire to have a family. Suffice it to say that, depending on one's life philosophy, there are numerous resources one can access for education about family planning (religious organizations, family planning agencies, personal physicians, et cetera). Having a child, whether by the standard biological method or by adoption, should be the result of a desire to have a child for the sake of raising a child, not as a result of spur of the moment passion or for the emotional needs of the parent. This is certainly a tall order, given the behaviors we see described in the news on a regular basis. However, if we, as a society, are to prevent child abuse and neglect, we most strive for the loftiest goals possible.

A parent must be a teacher. A child learns life's lessons by experience, to be sure. But a parent's guidance is necessary to assure those experiences are evaluated in the most advantageous light. Being an effective teacher requires knowledge of the subject matter (child development, in this case) and knowledge of self. Subsequent articles in this series will impart a basis for understanding the different stages of child development. However, a person can not effectively teach a child, or anyone else for that matter, without an understanding of his/her own learning style and basic philosophy of learning. It is this interior design that shapes our relationship with others. This design is fabricated from a combination of innate (genetic) learning style and life experiences. We are not suggesting that every parent need undergo psychoanalytic evaluation before having a child, but a certain amount of forethought and introspection is crucial to being the best teacher.

Once the decision to have a child is made, the next challenge is deciding when to have the child. Having a child should not be an accident (although we all know instances where a surprise pregnancy has supervened), an attempt to "keep up with the Joneses " or as a result of wanton behavior. This decision is an adult responsibility. Optimizing whatever a child's innate intellectual capacity might be requires, among other things, avoidance of metabolic toxins during pregnancy (tobacco, alcohol and illicit drugs) and seeking good prenatal care. Nature is very unforgiving in that if a person does not take responsibility for their actions, consequences invariably occur.

The timing for a first child depends on parental age and career plans. Parents require sufficient energy and time to devote to parenting. Although there is no endeavor as rewarding as being a parent, there is no undertaking that is more time or energy consuming. Although prospective parents may feel that financial considerations play an important role in planning to have a child, this is a less important element than the approach to parenting. There are many examples of poor wonderful parents and wealthy parents who do not have a clue about what good parenting means. As stated above, the ability to parent well is predicated on the desire to teach and love a child and being prepared to devote the necessary time and effort to accomplish these goals. Financial support is certainly helpful, but it is not the ultimate factor.

The decision to have children already having been made, the timing for a second child entails different considerations. If children are close together in age (i.e., less than two and one-half to three years), they tend to have more physical conflicts and competition as young children (increasing the intensity of parenting), but are usually closer as adults. If the spacing is greater than two and one-half to three years, there is less conflict as young children, but they may not be as close as adults. The ideal spacing seems to be, as you may have guessed, two and one-half to three years. That is not to say that other spacing will be detrimental to their relationship. As long as parents are aware of the potential consequences and are willing to modify their parenting behavior, the potential adverse outcomes can be averted. Mitigating factors in the decision on timing of subsequent children include the same ones as the decision for having the first child - parental age and career plans. Some parents want to have their children grown and out of the house by a certain time so the parents can be free to travel, et cetera. Other parents fear loss of energy and mobility if they begin their family at too late an age. The decision is specific to a family's individual needs. As stated above, as long as the parents are aware the possible outcomes and willing to modify their behavior, then there should be no problem.

The first child creates an entirely new family constellation, requiring a large adjustment in lifestyle for the parents. The second child is far less of a parenting adjustment because the mechanics are the same (feedings and diaper changing have already been mastered). Notwithstanding that statement, each child has their own personality and own needs that must be determined before they can be met. In a two-parent family, there is always someone who can attend to the second child. Each one, then, gets adequate attention. The advent of the third child makes life a bit more of a challenge. One parent is typically watching two of the three children. Somehow, they both seem to want attention at the same time. A single-parent family may find the same challenges with a second child. Additionally, the presence of the third child makes the second child a "middle child" who may have difficulty competing with the developmental acuity and skills of the older first child and with the infantile needs of the third child. The middle child is often the one that needs the most attention ("middle child syndrome"). A fourth child makes the score even again. It seems that odd numbers require the most parental adjustment.

Parents can never give the second child the same amount of attention that they gave the first child. The third child often gets more emotional attention from the older two siblings than from the parent. The more children, the more this scenario emphasizes child-to-child emotional support. Although parents often feel guilty about this, this set up actually enhances the sense of responsibility and independence of the children - not a bad outcome. The children grow up learning to share, rather than being imbued with the single child attitude of getting into the world thinking that everything belongs to him or her.

Subsequent articles will address some of the practical, as well as the developmental and behavioral, aspects of child rearing. Keep in mind that the basics tenets of effective parenting include consistent presence, consistent attention, teaching at every opportunity, being a good role model, being a child advocate and including the child's input into your decision making process (when the child is of an age that allows an opinion).

1. Pediatrics, July, 2005, page 281