In offices and clinics, in well and sick visits, pediatricians strive to enhance children’s physical health and emotional well-being. Yet a contemporary, anxious social pressure hampers your efforts. This destructive force weakens marriages and gets children overwhelmed. It contributes to some of your patients’ chronic belly aches, headaches, sleep disturbances, anxiety attacks, eating disorders, and overuse injuries. It also leads to discouraged kids being diagnosed as learning disabled or ADD, or to their becoming anxious, depressed, and suicidal. I call this pressure, “hyper-parenting.”

It exerts its influence through over-scheduling which compels well-meaning parents to enroll young children in intense activities in the hopes that their kids will excel at academics, athletics, or quirky specialties. Particularly in affluent communities, each high-pressure activity is said to be a critical step: Make all the right moves and your child will get into a top name university which will guarantee a successful life. Deprive your kids of these activities and their only acceptance letter will be to Southeast Kentucky State Junior College’s night extension program. They will have miserable lives, and you will have only one person to blame: Yourself. Given that equation, what choice do you have?

While hyper-parenting blossomed in the past 25 years, its roots lie in fundamental changes in childhood that began with the industrial revolution. Before then, most people lived on farms, practiced crafts, or ran small shops. Parents needed children! Kids’ work -- stocking shelves or milking cows – was essential to a family’s survival. It “spelled the difference between economic well-being and destitution.” (Mintz, 2004) Children’s work was so vital that childless farm families even recruited foster children from orphan trains because they needed their labor (Rosenfeld, Wasserman, and Pilowsky, 1998). For children, the need to work might have been harsh, but no one worried about getting an A+. It was pass/fail: You either did your chores or you didn’t!

Family relationships were clear. Whether or not you loved your father or mother, the Ten Commandments guided your behavior: You were to respect them. That was not so hard. How could you watch your father hitch a team of huge oxen to a plow, or your mother turn raw animal fat into candles, and not respect a person with such remarkable abilities? Parents who schooled their children in the skills and crafts they would need for adult lives could feel comfortable that they had done everything required to be considered “good parents.”

Formal schooling was far from essential: In many states, it became mandatory only in the late 19^th and early 20^th centuries. People who could neither read nor write could earn a living. Architects, engineers, doctors, and lawyers could learn their professions through apprenticeships. Abraham Lincoln had less than one full year of formal schooling before first becoming a surveyor and later an attorney; rumor has it he was pretty good at both!

But we don’t live that way anymore. Social security and a complex post-industrial economy have transformed our families. Rather than being contributors, today’s children – your patients -- are economically useless, financial drains on the family’s finances. We no longer work together with our kids to produce our daily bread; now our families’ primary shared activity is consuming: Playing, vacationing, “recreating,” and shopping.

That leaves a potentially weak glue to bind families together: Love. Avoiding starvation was a far more reliable adhesive. Love can be fickle. It takes unpredictable emotions and quiet time, something contemporary overscheduling –which requires perpetual motion – has made more difficult. This change has affected family life profoundly. In just the past 20 years, structured sports time has doubled, unstructured children’s activities have declined 50%, household conversations have become far less frequent, family dinners have declined 33%, and family vacations have decreased 28% (Rosenfeld, 2004.)

So much else has changed! Once, children were to be seen and not heard; today, parenting is America’s most competitive adult sport. Particularly among financially advantaged families, kids are showcased. We often hear of a child’s accomplishments, but rarely the simple praise, “he’s such a good (or good-hearted) kid!” One hundred years ago, work ended when the sun set. Today, electric lights allow homework to be done until midnight and ice hockey practice to begin before the sun rises. As children’s activities have become the center of family life, adult needs have been subordinated. And adolescents – who today become biologically mature three years earlier -- must remain social children until their mid 20’s or thirties. When is a Jewish fetus viable? When it finishes medical school!

We live in an age of science, data, and statistical analysis. A child-rearing style this prevalent ought to have robust empirical support. Over-scheduling to specialize in what you excel at at 5 does not. Anecdotal evidence suggests the opposite. Leonard Bernstein started playing the piano not at 4 but at 10; until George Gershwin discovered music, he specialized, apparently with considerable success, in being a child hoodlum. Unlike Tiger Woods’, Michael Jordan did not make his high school J.V. basketball team at first. Furthermore, many exceptional people find their calling overcoming a handicap: James Earl Jones developed that fabulous voice in the struggle to surmount his speech impediment. Analogously, I suspect that most physicians pick a specialty that tried to cure an illness that they – or someone they love – suffered from.

Enrichment activities can add enormously to making life full and meaningful. They can help children find their passions, teach the value of teamwork, and help build friendships. Even parents who expose their kids to numerous different activities often seem to be operating on the notion that if a little is good a lot must be a lot better, many children are enrolled in multiple, “one size fits all” standard programs like soccer, music, and Mandarin. The balance between scheduled enrichment and down time is often lost and each child’s preferences and temperament may be overlooked.

Many of you regularly hear about hyper-parenting in your pediatric offices. You ask a child what they do after school and their frazzled looking, but proud, Mom answers, "Monday-soccer and math tutoring, Tuesday, soccer then piano, Wednesday religious school, Thursday –long soccer practice, but Friday is free, which leaves the weekend for soccer games both days because Liz was so good she was selected to be on the town’s travel team.” The combination of managed care and your own parenting likely has you ridiculously over-scheduled. Yet you, her pediatrician, feel exhausted just listening to this list. Imagine how poor Liz feels! 

Let me mention a few other ways this over-scheduled madness expresses itself:

1. For newborns, whole states have jumped on the bandwagon. Because research supposedly “proved” that listening to Mozart in infancy enhanced mathematical ability, Governor Zell Miller – who, using his characteristically superb judgment, once suggested settling a difference of opinion with Chris Matthews in a duel -- signed a bill to send every Georgia newborn home with a Mozart CD. The research that decision was based on was done on college students, had no comparison group, and the effect was very short-lived.

   No one researched whether Mozart was superior to Mahler, Mick Jagger, whale songs, or the Dixie Chicks. What would parents and pediatricians recommend if really good research proved that the music that most promoted children’s brain development was Gangsta Rap? Would you recommend playing it in nurseries all day?

   When the kids are a bit older, parents come to believe that to do their job right, they need to products like Baby Einstein. Parents like the Einstein image – whose child isn’t a genius?– so they don’t carefully contemplate its implications. While adult Albert was a genius, he talked late, did poorly at school, and had a headmaster who said he would never amount to anything. If he were alive today, his parents likely would get him a comprehensive evaluation: If he weren’t diagnosed as autistic and needing early intervention at two, by seven he would be on Ritalin. He might not invent the theory of relativity but he would certainly attend far better to fourth grade math!

   Isn’t great that post-marketing research now has shown that Baby Einstein tapes are not false advertising! They actually do help your kid become a BABY Einstein, possibly retarding speech development?

2. What about school aged kids? Under pressure from parents, suburban schools have increased homework for children as young as fourth grade. Yet empirical research has detected no correlation between the amount of homework elementary school students do and later achievement. In fact, some say that too much homework could actually hurt­ school performance. But despite the facts, homework increases. Assignments make parents near full-time homework helpers. As a result, some schools have divided the way projects, like second grade dioramas, are graded, into those the child clearly made, and those that parents seem to have helped with just a little bit, because Josh’s zebra habitat looks like it had been designed by Frank Lloyd Wright.

3. As you know, hyper-parenting has repealed fundamental laws of statistics! No school-aged child you examine is average. Each is either gifted or learning disabled. And if they are not gifted, they probably need Adderall.

4. In high school, this over-scheduled mentality has adolescents sleep-deprived as they rush between activities, endless homework, and the requisite community service. They, and their parents, often think that they can get by on five or six hours sleep even though experts say that sleep deprivation has negative effects on behavioral control, emotions, and attention (Dahl and Lewin, 2002). Kids look for “unusual” sports or instruments to play:

   One girl desperately wanted to go to Brown. All through high school, her mother told her that the French horn was her ticket in. At her Brown interview, she was asked about many things; when the interviewer finally asked her a question about the French horn, she lit up because her moment had arrived. But he quickly moved on; she was crestfallen. Some time later the interviewer noticed that the girl was also a recreational ice skater. He looked at her, and asked, “Do you think you could play the French horn on ice?” She laughed because she was sure he was kidding. But he explained that they needed a French horn player for their ice hockey support band. So never doubt a mother’s prescience; her daughter got into Brown.

Other than in video games, adults have colonized what traditionally was children’s after-school world. Kids want to play sports. As Engh (1999) points out, 78% of children would rather be out on the field for a losing team than warm the bench for one that wins. Kids have fun playing, can develop an ease with their bodies, learn about teamwork and sportsmanship, enhance their self esteem if they are good athletes, and find a physical activity that gives them pleasure and a sense of physical well-being for the rest of their lives.

But kids’ sports have been professionalized (Bowen and Levin, 2003.) The American Academy of Pediatrics warned parents about the dangers of competing in demanding, incredibly competitive sports. They strongly advised that pre-pubertal children play multiple sports and specialize in one if they must, only after puberty. But competitive pressure has insinuated itself even into soccer leagues for four year olds.

By ten, towns cherry-pick travel and premier teams. As you know too well, ill, injured, and concussed kids are pressured to return to their competitive teams long before their pediatrician says they are ready. A recent Washington Post article states that “at least 300,000 sports concussions occur in children annually.” (Levine, 10/10/06) Yet soccer coaches still ask their young players to head the ball and as the New York Times pointed out, football and hockey players with multiple concussions often keep that malady secret because they think it is so critical that they play.

Eleven year old pitchers hurl 90 games a season. The fallout is substantial. Orthopedic surgeons report between 2.2 and 3.5 million recreation-linked bone fractures, dislocations, and muscle injuries annually among 5-14 year olds. Is it winning to need both your shoulders replaced in your 30’s, as one elite gymnast I met had to (Rosenfeld, 2004)?

Since many kids hate the pressure, are only local team quality, or don’t get much playing time, by age 13, 73% drop out of sports (Engh, 1999). Ironically, the resulting  lack of exercise may be contributing to America’s obesity epidemic.

What other harm does over-scheduling do? Contemporary parents know that in everyday life, self-esteem is intimately tied to happiness. Yet over-scheduling’s focus on activities rather than on the individual – in combination with the freneticism and criticism associated with it -- often diminish kids’ self-esteem; it makes them feel, "I must not be very good at all or I wouldn’t need constant self-improvement." Parental scrutiny and over-scheduling can also create a self-fulfilling prophecy: After all, the child resents the parents’ lack of faith in them and, to get even, may live down to that expectation!

How does the stress manifest itself? You see middle and upper class adolescents who complain of stomach aches, headaches, and exhaustion. I think that pressure to accomplish -- rather than to develop who you are and to discover what you yourself value – is a factor in why so many teenagers have these symptoms.

They may mask a depression or despondency. Some kids become rebellious, taking alcohol as a way to relieve emotional distress, or illicit substances to escape into drug-induced daydreams. Johnston, O’Malley, and Bachman (1998) found that by 12^th grade, affluent youth reported the highest rates of marijuana, inhalant, and tranquilizer use. Even with the declines these authors recently reported (2005), half of students will have tried an illicit drug by the time they near H.S. graduation. Working in an affluent Connecticut suburb, Columbia’s Luthar and Becker (2002) found that teen-aged drug use was likely associated with the “overemphasis on achievement.” As one depressed, substance abusing patient of mine told me, “In my family it is Harvard, Yale or nothing and I just can’t measure up.” And in college, alcohol is an epidemic but how else do you relax in a pressured environment where works seems to be endless?

Anxiety is also a concern. Close to 9% of affluent teenagers suffer from generalized anxiety disorder, overanxious disorder, excessive shyness, panic disorders, and obsessive compulsive disorder, not counting the many who have eating disorders. That is a wild under-estimate since only kids with a serious functional impairment arising from their anxiety are counted as having a disorder.

Does hyper-parenting give kids the good life? Some empirical evidence suggests that the “winning is everything” notion emphasizes values that encourage exactly the opposite. For over a quarter of a century, Vaillant (2002) has been conducting longitudinal studies of people’s lives. Two variables that seem to predict a good life include meaningful relationships and enjoying playing without goals.

Vaillant’s findings parallel what I see in clinical practice. First, relationships make all the difference. Acceptance brings out the best in everyone; anxiety the worst. If someone loves and trusts you, and you have a capacity to love and trust them back, your whole life is better. But over-scheduling introduces stresses into family life that can compromise intimacy.

Parental acceptance does not translate into “anything goes.” Every devoted parent needs to push their kids some; children need to know that their parents expect them to make something of their lives. But within the context of a nurturing relationship, it is the children – not their parents -- who have to do the very hard work of figuring out what they hope to become. There is great value in that! When they do, they feel like the authors of their lives, rather than like marionettes in someone else’s play.

Furthermore, striving for awards in scheduled activities devalues the capacity for true play. Einstein maintained that “imagination is more useful than knowledge.” Yet society treats children’s imagination as less precious than athletic awards, and thereby devalues creativity. We criticize our kids when they just want to lollygag; we also fault ourselves for not finding more for them to do.

But isn’t parenting is a higher calling than emulating cruise ship activities directors? Furthermore, boredom can be beneficial; it can stimulate kids to hear the soft murmurings of their inner voice, the one that makes them write this unusual story or draw that unique picture.

America’s economic success is based on people who bucked conventional wisdom, followed their inner passions, tinkered, and created, people like Alexander Graham Bell, David Packard, Matt Groening and college dropouts Michael Dell and Bill Gates.  Had Alexander Graham Bell been as over-scheduled as our kids we might still be using carrier pigeons to communicate!

Elite schools often fail to recognize truly creative kids. One young man desperately wanted to make films. He applied to UCLA’s prestigious film program: Rejected! So he went to Long Beach State. Later he applied to USC’s film program. Rejected again! But he was tenacious. His name, Steven Spielberg! Not very long ago, another young man in nearby New Jersey did poorly in high school and was told that he was a junior college kind of kid. Since his family had little money, he went to junior college and became a part-time firefighter to pay the bills. At junior college, a history course turned him on; he began to work and to succeed. His name is Brian Williams, the NBC news anchor.

Too often, we parents treat public accolades – our child winning the soccer trophy or the spelling bee -- as the true measure of people. In doing so, we may abrogate another fundamental parental responsibility, teaching children character. Kids with character stand out. I bet you recognize them the moment you see them in your offices.

How do kids acquire character? No kid I know listens to what their parents say. Intelligent children watch what their parents do. Does a parent’s life model standards they hold the kids to? Do they kowtow to wealth and station or value people of character, rich and poor alike? Do they drive home tipsy after a party? Do they treat others with dignity? Do they strive to be close to friends and to get balance in their lives? Do they make time for pleasure? Do they read books and love to learn? Do they listen to others and modify their opinion if someone – even a child -- makes a better, more cogent argument?

In this age of anxious hyper-parenting, parents sometimes lose balance and wear how frazzled and self-sacrificing they are as merit badges. Every good parent sacrifices plenty but competitive parenting – and being a winner in the parenting Olympics -- helps no kid I’ve known. To have enough energy and good humor to nurture their children, parents must have a life too. Yet the intense stress over-scheduling insinuates into parents’ lives combined with work pressures means that they may suffer from the same anxiety, depressive, and stress-related disorders as their children. At least the adults in my practice often do!

Every kid I’ve known whose parents were pleased with their lives did far better. So to raise happier kids, parents need to be encouraged to also enjoy themselves and their spouses more. For their children’s sakes, couples need to have more fun in bed!

In the ten unscheduled seconds you have during a pediatric office visit, what can you do? You are in a unique position since many parents trust their pediatrician regarding child rearing, likely more than anyone else. Ask about activities. If the family seems over-scheduled, you might keep a few principles in mind:

1. For starters, support a child’s right to be not a professional but a kid. Childhood is a preparation not a full performance. Many parents need their pediatrician’s support to resist the pressure from coaches, the media, and neighbors that tells them they must push their child to excel early. Parents and kids, not coaches, have to make those choices.

2. Encourage over-scheduled families to cut back 5-10% on activities. For many families, that translates into just one or two weeknights a month. Families may find that with just that much more down time, life becomes sane again.

3. As pediatricians, you can help parents realize that limiting activities does not mean they’re bad parents. It says that they are responsible adults who make hard, sensible choices for their families. That is what is difficult about being a good, nurturing parent. Isn’t that what we are asking our kids to do when we tell them to just say “no” to poisonous temptations?

4. You see so many types of “good parents” with differing child-rearing styles. Assure parents that no one-size-fits-all approach makes parenting good. It is an ever-changing dance, a unique balancing act between parents, children, spouses, extended family, friends, and the community at large. Because parents are doing a dance that has never been done quite this way before, they will sometimes feel awkward. That is “the human condition.”

5. Our children are with us for but a brief flicker of time before they become busy with friends, college, jobs, and eventually their own families. Nothing is more valuable than family time. Encourage families to be unproductive, to have time together with no goal, shooting hoops, taking walks, or watching a movie. And with your encouragement, maybe they will make more time to talk and listen to their kids.

As pediatricians, you can help insecure parents appreciate that their children need more time with Canadian ice hockey coaches far less than they need time with their Mom and Dad! Nothing bolsters a pre-teen’s self esteem more than being with parents who enjoy spending time with them with no apparent goal. It stimulates their deep, inner conviction that they don’t have to perform for us to love them. That used to be called unconditional love. Billy Joel captured it: No need for clever conversation. “I love you just the way you are.” Who among us is not looking for that?

Life has never been carefree; childhood and adulthood have always had their anxieties. But as Sigmund Freud insisted, living well means enjoying life, working, and loving despite the anxiety that comes with being mortal. That’s not a bad aspiration for me or you, and is not a bad one for the families and children we serve!

THANK YOU!

References

Bettelheim, B, Rosenfeld, AA (1993), The Art of the Obvious: Developing Insight for Psychotherapy and Everyday Life, New York, Alfred Knopf.

*Bowen, W, Levin S ( 2003) Reclaiming the Game: College Sports and Educational Values, Princeton, NJ: Princeton University Press.

Dahl RE, Lewin DS (2002), “Pathways to adolescent health: Sleep Regulation and behavior,” J Adolesc Health 31:175-84.

Engh, F, (1999), Why Johnny Hates Sports, Garden City, New York, Avery Publishing.

Johnston LD, O’Malley PM, Bachman JG (1998) “National survey results on drug use… Secondary School students,” Rockville, MD, National Institute on Drug Abuse.

Also see http://www.monitoringthefuture.org/ for 2005 update.

Levine, Susan (2006) “Playing Through Pain…” Washington Post, October 10, 2006, page A01.

Luthar SS, Becker BE (2002) “Privileged but pressured: A study of affluent youth,” Child Development, 73, 1593-1610.

Mintz, S. (2004) Huck's Raft: A History of American Childhood, Belknap Press

Rosenfeld, AA, (2004) “Harvard, Soccer, and the over-scheduled child.” Youth Studies Australia, 15-18.

Rosenfeld, AA, Wasserman, S, Pilowsky, DJ, (1998) “Psychiatry and children in the child welfare system.” Child and Adolescent Psychiatric Clinics of North America--7(3), 515-536.

Rosenfeld, AA, and Wise N (2000) The Over-scheduled Child: Avoiding the Hyper-Parenting Trap, New York, Griffin/St. Martins (first published as Hyper-parenting.)

Steinberg, J (2002) Gatekeepers: Inside the Admissions Process of a Premier College, New York: Viking.

Vaillant, G (2002) Aging Well: Surprising Guideposts to a Happier Life from the Landmark Harvard Study of Adult Development, Boston: Little Brown.