Care and Feeding

My 4-Year-Old Just Started Talking About Herself in a Disturbing Way

Where is this coming from?

A little girl cuddles with her teddy bear in bed.
Photo illustration by Slate. Photo by Getty Images Plus.

Care and Feeding is Slate’s parenting advice column. Have a question for Care and Feeding? Submit it here.

Dear Care and Feeding,

My 4.5-year-old daughter recently said something I wasn’t expecting. At bedtime she said: “I hate myself.” She’s said this now a handful of times, always after telling me how much she loves me and how I’m the best. She is cheerful when she makes these comments.
She’s quite a jokester in general, so it’s not clear to me whether she really understands what she’s saying, or if she’s being serious.

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My response has been to tell her that I love her and that loving ourselves is very important because it’s the longest relationship she’ll have with anyone. I’ve also told her that if there’s anything that’s making her sad she can always talk to her dad or me. When I try to ask her why she hates herself, she just repeats that she hates herself (still in a cheerful tone) and nothing more.

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Beyond her statement she’s not acting any differently—she’s still a bubbly, sing-songy, loving, silly kid. But, of course, it kills me to hear her say this, joke or not. No one in our family talks negatively about themselves, or her, so I’m not sure where she’s getting this. Am I addressing this in the right way when she makes these comments? What else should I do or say to make sure that she is ok and to help her have a positive self-image?

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— Hurts My Heart

Dear Hurts My Heart,

While upsetting to hear, occasional negative self-talk is not necessarily a cause for alarm on its own. Given that kids your daughter’s age aren’t adept at communicating their feelings  yet, blanket statements like “I hate myself” or “I’m a bad kid” may be standing in for a more specific emotion they don’t know how to name.

Since it’s painful to hear our kids express negative feelings, it is tempting to automatically dismiss or contradict what they’re telling us. But our job isn’t to protect our kids from hard feelings, it’s to teach them how to cope with them. With my son, I try to instead validate his feelings by mirroring them back to him, by saying something like, “I hear you saying you feel frustrated/angry/sad/bad/etc. That sounds hard.” In the case of negative self-talk specifically, you should offer specific examples of things your child is good at or times they succeeded like “Yesterday you told that great joke that made everyone laugh” or “It was so kind when you shared with your friend in the park after school.”

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Speaking as the (white) mother of Black son, your question also reminded me that it was around your daughter’s age that my son began to occasionally say things like “I hate my skin” and “I wish I was white,” which to me signaled his increasing awareness of the way whiteness is positioned as the cultural ideal. I don’t know your daughter’s race, but kids of color in general are more vulnerable to developing a negative self-concept and internalizing racism. This can be somewhat combated by exposure to positive representation and education about racial identity that helps instill a sense of cultural pride.

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Ultimately, it sounds to me like you’re already doing the right things, but if your daughter’s negative self-talk begins to be coupled with other behavioral changes, or if these feelings start to affect her everyday life, I’d get her evaluated by a mental health professional.

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Submit your questions about parenting and family life here. It’s anonymous! (Questions may be edited for publication.)

Dear Care and Feeding,

I’m looking for some help to manage my child’s anxiety of necessary medical experiences. I’m talking immunization, regular doctor visits, dentists, even getting a splinter out!

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Our boy is 8, and we are fairly confident he is neurotypical, and no teacher or caregiver has suggested we have him assessed. He is meeting all his milestones and is a confident and happy child. However, when he is required to endure an uncomfortable experience along medical lines, he has a complete meltdown, becoming frightened and crying. When he had to have a COVID PCR test, it was like a hostage negotiation situation for 20 mins, and the staff actually told us they couldn’t do it until eventually I had to hold him down. Same deal for vaccines.

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Recently, I took him to the doctor because of a fever and a sore tummy. He wouldn’t allow the doctor to depress his tongue to see in his mouth (nor would he press it down himself). The doctor then checked his temp with an ear thermometer and the feeling upset him so much he started bawling. He wouldn’t let her examine him at all after that. She was unable to examine his ears with the ear scope. When she asked him to lie on the examination bench so she could feel his tummy, he curled into the fetal position and then screamed that he wouldn’t let her touch him. At the dentist, he wouldn’t let them perform an x-ray because he wouldn’t bite down on the film or wear the protective vest.

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I’m absolutely at a loss for what to do here. I have tried to be as respectful as possible and always explain things to him and try to give him some control over the situation. But at 8, he’s a big kid now and this all feels like very untypical behavior for that age. Medical staff become exasperated by him, and it’s quite frankly really stressful and humiliating. How long can he go on avoiding examination by the dentist, the doctor, etc.?

— Doctor Drama

Dear Doctor Drama,

I KNOW THIS LIFE WELL. My 11-year-old also struggles with intense anxiety around medical situations, and every routine vaccination or dental cleaning has the potential to become a huge ordeal. If your son is anxious in general, that could be worth checking out—especially since the U.S. Preventive Services Task Force currently recommends screening children for anxiety beginning at age 8 anyway. But it’s hardly unusual for even adults to experience high anxiety about visiting the doctor or dentist; they’re just more likely to not go at all than to have meltdowns in the exam room.

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There’s no denying that getting an anxious kid through essential dental and medical procedures is incredibly stressful, but I’m going to suggest you attempt a mindset shift when it comes to your feelings of humiliation. After all, your son is presumably seeing doctors who work with children as part of their job description. When these doctors become visibly exasperated or treat my child as an annoyance for reacting to a scary situation like a child does, I consider it to say more about their bedside manner than it does about his behavior.

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And while we’ve been to doctors who gave up immediately when my son was being a difficult patient, there are medical providers out there who are wonderful, and wonderfully patient, with anxious kids like ours.

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When my son needed a painfully infected baby tooth pulled, we went to and were turned away from three oral surgeons before we finally found one who knew exactly how to get the job done—he wrapped my freaking-out son in a blanket like a burrito and had the offending tooth out in under a minute, then sent us on our way with a stuffed koala for bravery. Let medical providers know in advance that your child struggles with intense anxiety and ask about their skill level and strategies for working with kids like him. A scared kid should never be treated like an aggravation or an inconvenience.

Also, remember that your kid will pick up on and mirror your mood, so try to stay calm even though the situation is frustrating. When logistically possible, distracting your kid from a procedure with toys or videos can sometimes help. And when all else fails? Honestly, try bribery. It took a significant Robux investment to get my son through his COVID vaccine, and I have zero regrets.

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Slate Plus Members Get More Advice From Emily Each Week

From this week’s letter, I Can’t Believe This Dumb Sport Is About to Ruin My Great Co-Parenting Relationship: To me, this is a hill worth dying on.”

Dear Care and Feeding,

I live in a country that celebrates a tradition that I am, at best, uneasy with. It involves a bizarre ritual by which parents of small children routinely lie to them about the existence of an elderly domestic intruder who supposedly brings small chocolate statues of himself along with toys and gifts once a year (spoiler alert: the lying parents buy this stuff). These are otherwise reasonable people who do their best to teach honesty, good communication, integrity, and the like to their kids. I’ve assimilated well to these locals to the point that I, too, am complicit in this charade, along with almost all my neighbors, friends, colleagues, all their relatives, so basically everybody here. I want to teach my kids about the shamanic origins of this intriguing but overly caricatured figure, instead of fat-shaming him with cookies and milk (seriously). It’s important to me to keep (or at least regain) their trust despite this betrayal. How do I come clean to my kids, who are 7 and 4 and have grown to embrace this tradition?

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— No Gaslight

Dear No Gaslight,

While your delivery and tone here is perhaps a bit over the top, I do understand where you’re coming from. I felt similarly conflicted about straight-up lying to my child in the service of holiday magic, largely because I remember that when I learned the truth about Santa Claus as a child, my first thought was, “So what else are they lying about?” Luckily for me, my logical and extremely cautious Virgo child never really bought the whole thing anyway. (“So a guy just comes into our apartment at night? Sounds unsafe.”)

I’m not totally sure why you told your kids the Santa story in the first place if you felt so strongly about it, but I think the best approach moving forward is to wait until they begin to ask questions or express doubts about Santa, and then encourage that critical-thinking. Gaslighting would be looking them in the face and reinforcing the lie when, let’s be honest, the story never really checked out. Instead, use questions like “What makes you ask that?” and “What do you think?” to help them come to their own conclusion. If asked directly to confirm or deny the existence of Mr. Clause, I’d err on the side of being direct and honest.

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These days, my co-parent and I emphasize that while Santa Claus the actual person is make-believe, the spirit of Santa Claus is real and something we can all embody by being kind and generous to others. There’s also this approach that floats around the Internet and goes viral every few years, in which you explain to your children that they themselves are now ready to become Santa. Since this conversation is likely to happen with your older child first, remember to tell them not to break the news to their sibling or other children. And here’s the silver lining: You can finally stop spending Christmas morning mentally screaming, “IT WAS ME, DAMNIT, I BOUGHT THOSE PRESENTS!!” while your kids are effusively thanking Santa.

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Dear Care and Feeding,

I have two kids, a 10-year-old son and an 8-year-old daughter. Each has their own room with a full-size bed. Since they were little, they’ve chosen to sleep together rather than sleep alone. I find this incredibly sweet and it has honestly made things like travel way easier for us as a family. I assumed they would eventually choose to sleep apart on their own but they show no sign of being interested in that (they generally recoil in horror when I suggest it). So what say you? Is there an age at which I impose a mandatory own room/bed policy? Does gender matter in this case? Or do I just appreciate that sleep seems to be going well around here and not make problems for myself?

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— Sleeping Siblings

Dear Sleeping Siblings,

In order to meet the guidelines for safe co-sleeping, bed-sharing kiddos need to be over a year old, but I can’t find evidence that they need to be separated at any specific age. In fact, children sleeping alone is a fairly recent phenomenon, and for much of history and in many other cultures, sleeping with a family member (or your whole family) was the cultural norm. Not to mention that plenty of families have no choice in the matter due to financial limitations and/or limited space. There’s nothing weird or inappropriate about this, certainly not at this age.

It is incredibly sweet that your kids are close enough to enjoy sharing a bed, and also great that you have the ability to provide their own spaces when they want them. According to the experts, the arrangement is likely to end naturally around the onset of puberty, when one or both kids decide they require more privacy. If you and your kids are happy with the current arrangement for the moment, so as long as everybody is getting a good night’s sleep, I don’t see any reason to worry.

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—Emily

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