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Daily Dose

Your Child's Emotional Health

1:30 to read

It seems that half of my day in the office was spent with children and their parents who were dealing with anxiety.  I am concerned as I am seeing younger patients who are presenting with symptoms of anxiety which may include difficulty sleeping, recurrent tummy aches or headaches (without physical findings) and school refusal.  While pediatricians are trained in taking care of sore throats, rashes, coughs and colds, there doesn’t seem to be enough training in dealing with mental health issues in children. Unfortunately, mental health issues are becoming more and more prevalent and a part of almost every pediatricians practice.

 

The American Academy of Pediatrics (AAP) has recently released its first policy statement entitled “guidance for nonpharmacologic mental health care”. In other words, looking for methods to help children with emotional and behavioral problems, both of which may impact a child’s growth and development.

 

There is a growing body of evidence that supports “family-focused therapies” for improving emotional, behavioral and relationship problems for all aged children.  Some studies estimate that 7%-10% of children face emotional or behavioral problems, and at times I feel that this number is actually much higher. Regardless, these issues have a huge impact on both a child and their family and if they persist may have long-lasting effects and consequences.  

 

I am so appreciative of parents who are honest with me and are open to discussing nonpharmacologic therapies for addressing initial behavioral and emotional concerns in their children. While some parents are wanting “a drug” to improve (fix) their child’s symptoms, many parents understand that the best way to approach these issues may be with other mental health services. These may be provided by trained counselors and psychologists who use play therapy, cognitive behavioral therapy, and family therapy to improve a child’s mental health and well being.

 

I am a big believer in early interventions to help teach a child how to deal with their feelings and emotions when they are sad, angry, frustrated, anxious or over whelmed. As adults we may “have figured out” how to deal with these emotions, but in many of the children I see, their parents have some of the same issues that may also need to be addressed.  You know, “the apple and the tree” theory is still true…children are a product of their genetic material and mental health issues are often familial. As stated in the AAP guidelines (the airplane analogy), “parents need to put on their oxygen masks first, before they can support their child in a sensitive, patient and consistent  manner.” 

 

Remember that your pediatrician is “your partner in parenting” and discussing emotional and behavioral concerns is part of the relationship.  Don’t avoid a needed conversation. 

 

 

 

 

 

  

Daily Dose

School Anxiety

2.00 to read

For some of the country school has been in session for a week or two, but September brings the reality of school for all. So I was not surprised to listen to my voicemails recently only to hear numerous messages relating to the return to school.

One of the predominate themes I heard was, “my child seems anxious about school”. Interestingly, the voice mails related not only to young children who might be starting school for the first time, but there were also several calls relating to adolescents in junior high and high school. The “worry” that some children experience as they return to school after 10 -12 weeks of “down time” occurs quite frequently.

Many of us, even adults, get the “butterflies in the tummy” feeling when embarking on a new situation. Whether it be a new school year, or a new job,   along with anticipation and excitement might come a bit of anxiety. At times the anxiety may present itself as a tummy ache, headache, difficulty sleeping, loss of appetite or even lethargy.

Everyone responds to anxiety a bit differently. But many times these symptoms go hand in hand with feeling anxious. These feelings are not wanted or planned, but result from our mind/body interaction as neurotransmitters in our brains may produce outright symptoms in our bodies.

There will be many children who have a mystery headache or tummy ache for several days, maybe even several weeks, as the routine of a new school year begins. For most of our children these feelings will pass with a little TLC (tender loving care),  some of my young parents don’t know what this acronym means.  For other children the symptoms may be a little longer lasting and the school nurse might offer her own version of TLC, with a few minutes of rest, or a glass of juice, some reassurance and return to class.  The school counselor may also lend an ear to an older student who just needs some talk time in order to become less anxious.

But for a few, the symptoms do not pass and the anxiety surrounding school may even start to affect other activities. This is especially disconcerting when it seems to involve activities that a child had previously enjoyed, such as dance, or sports or even spending the night with a friend. In these cases it may be time to discuss your child’s anxiety with your pediatrician.  There are numerous professionals that can help your child with anxiety. So, give the back to school routine a bit of time, but at the same time if things are not improving, do not hesitate to call for outside help.   

I'm Dr. Sue and that’s your daily dose for today. We’ll chat again tomorrow. 

Daily Dose

Anxiety Can Happen At Any Age

Why are so many kids filled with anxiety and stress?This was a hectic week in my pediatric office. I was busy answering voice mails, emails, "tweets" and it is interesting to me that most of my messages are related to children with anxiety.

Why are we raising such an anxious group of children? Is it that the "gene pool" has changed or is it just societal? I really think that it is due to our society as a whole, we are on the fast track to creating the next generation of "stressed out" adults, even more so than ever, if that is even possible!! I will just walk you through my voice mails, as it really is interesting that my phone messages are from parents with children of all ages. There is the preschooler who won't get dressed in the morning for school due to a constant tummy ache. There is an elementary school child who is having problems sleeping every night, and a tween who is getting tics when she gets anxious at school. I also take care of a large number of college students and I have two patients who left college after their first semester as they were anxious and depressed while being away from home and did not go to class and therefore did not make their grades. In each case the parent is calling to ask what to do? I only wish I had all of the answers!! I will get on that proverbial "soap box" and go out on a limb and say that after practicing pediatrics for 25 years the problems that are related to behaviors in our children are much bigger issues than anything else. We have made great strides in disease prevention, but we are definitely not preventing emotional issues in our children. Being a parent and a child seems to get only more difficult each year. Was that the way it always was? Did our own parents think we were anxious and "stressed out"? I don't even think that was a word in the 60's, 70's or even 80's. Just the same way that everyone now says, "I am busy running errands", (I know I never heard my mother use that term), our kids talk about "stress" from very young ages. Do we as parents put that pressure on them from an early age? I know that my new parents feel "stressed" that their baby does not sleep through the night by two to three weeks, and say "what are we doing wrong?" Answer, nothing, infants are not supposed to sleep through the night at that early age. Don't set the bar so high so early! I have parents of toddlers who worry that their child cannot jump as high as their friend's toddler (I don't even know how high that might be, are their standards for the playground?). I must say it just goes on from there. I know we parents are supposed to worry, but I think that constant worry is creeping right into the skin of very young children and it is "causing" anxious children. Yes, some children are just born that way, but most are not. I am not saying that a little bit of worry cannot be beneficial at times. It is okay to "worry" about doing well in school, or making new friends, or misbehaving and getting punished or eventually how to get into college and "what will I do with the rest of my life". But balancing a little worry with constant anxiety is become more difficult. Most of my referrals are no longer to the orthopedic surgeons for broken bones, but rather to psychologists and psychiatrists to help children and adolescents deal with anxiety. There are even recent articles regarding the fact that there are not enough pediatric psychiatrists to care for the burgeoning needs in the pediatric population. I wish I knew the answers, but I really do think that we can change things, be it ever so slowly. Getting back to the basics of "down" time with family and friends, rather than lessons, tutors, and Kumon math for 3 year olds! How about less time on computers and phones and more time spent face to face talking. How about listening to our children rather than having them watching DVD's on the way to school or while out at dinner with the family. So many little things that we can all change may make a difference. We have to start trying something different, as what I am seeing now is not "the happy go lucky" children of years gone by. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue right now!

Daily Dose

How To Soothe Back-To-School Jitters

1.45 to read

It is not uncommon for children to be both excited as well as apprehensive about the start to a new school year.Where has the summer gone?  Do you feel like I do and think, I blinked and POW it's back to school!  There's a lot of excitement for the new school year but some are feeling a bit nervous and anxious.

It is common for children to be both excited as well as apprehensive about the start to a new school year. Being a little worried about heading back to school is normal. Whether your child is going to the same school, but concerned about their new teacher, or starting a new school, the underlying uncertainty is normal. I can remember lying in bed the night before the first day of school and being so excited that I couldn’t sleep. I was always most excited about what “new outfit” I was going to wear. My mother had of course taken me shopping weeks before for the “back-to-school” skirt and sweater, and I just couldn’t wait to get to wear my new clothes. Back-to-school jitters are normal and should be discussed several days before school begins. It is very common for a child to have anxiety and stress related to a new school. But it is also not uncommon for children to worry about little changes related to such things as new lockers, cafeteria changes, a new teacher, or new friends. Some children will complain of tummy aches and headaches with the beginning of school. I am always reminded that I rarely hear children complain of a headache or tummy ache during summer vacations. These “aches and pains” are often a manifestation of a little underlying anxiety, and seem to be a September – June phenomena. A little parental reassurance will often help relieve those aches. The best plan for dealing with back-to-school jitters is to acknowledge the anxiety and plan on how to deal with it. Make sure that your child is rested for the first day of school and they have a good breakfast to start off the day. On the way to school discuss all of the positives for the new school year. Make your goodbyes short and sweet. Let your child know you will be there at the end of the day. Do not let your child see you upset, as sometimes parents too are anxious about the first days of kindergarten, high school or even college. Those back to school pictures are memorable and you will always like looking at the pictures with everyone smiling, even if your parental heart is a little sad at letting go. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

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Back to School Stress

Daily Dose

Separation Anxiety

What can a parent do when their child has separation anxiety?I received an email via our iPhone App from a mother who was concerned because her toddler son was crying when they left him at day care.  They were “alarmed” as he had not previously cried when they dropped him off and wondered if this was “normal” or a sign of a problem.

Actually, this phenomenon should be quite reassuring to a parent as this is a sign that your child is developmentally on track, and has developed a healthy attachment to his parents. All children go through periods developmentally when they are more prone to separation anxiety.  As a new parent you are often concerned about “leaving” your child under the care of someone other than a parent. But, in actuality, it is far easier to leave a newborn or an infant than it is to leave a 8-9 month old. By the time a child reaches this age they are beginning to show signs of stranger anxiety. In other words, they now recognize the faces and voices of their parents, routine caregivers, siblings etc. But, when a new person (and face) reaches out for a 9 month old it is not uncommon for that child to suddenly panic and burst into tears. This is not because the “stranger” has done anything at all, but because the child now understands being separated from their parent and may fear that the parent is leaving forever. The bond between parent and child has been successfully established, which is quite healthy. This is the beginning of teaching a child that a parent may leave for work, school or even a trip, but that they will return.  Just because a parent leaves for awhile, they are not gone forever. This first stage of separation anxiety can provoke feelings of anxiousness in both child and parent, but it is an essential part of normal development. Separation anxiety, like almost all behaviors, varies from child to child. While some childen are more clingy than others, some may just be “wired” in a certain way and are more vulnerable to  separating from a parent. Regardless, it is important for a child to begin to deal with healthy separation. During the ages of 12 – 24 months separation anxiety seems to peak, and the period of crying or anxiety when a parent drops a child at day care or Sunday school, or even at a grandparents house may escalate. While a child may cry after being dropped off, most children will then calm down and may be distracted and will begin playing soon after the parent has left. Again, some children just seem to take longer to adjust, so don’t be alarmed if  one child cries for 2 minutes, while another may take up to 20-30 minutes to settle down. Toddlers do not understand the concept of time, and therefore each one may react differently.  While happily playing while the parent is gone, it is not uncommon for the child to cry again upon seeing their parent when being picked up.  For the toddler, the return of the parent may remind them of how they felt when the parent left earlier in the day. For most children separation anxiety decreases between 2 -4 years of age as you can explain,  and a child can understand,  where you are going, how long you will be gone etc. For children who have rarely been left with others, it may be more difficult at this age.  Remember, healthy separations are important for both parent and child, and the idea that no one will “babysit” or care for your child other than a parent is not realistic nor does it teach your child to build trust in others. The more experience a child has had with earlier normal periods of separation the easier different transitions will be.  Remember, they will all be going to school one day and you want to prepare them for that separation. Lastly, every child has good days and bad days and almost every child will have a phase when it is harder to separate than others. Just remember to hang in there, be re-assuring to your child when you leave them, do not prolong the departure, and be understanding about their anxiety. As with so many experiences in parenting, “this too shall pass”. That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue now!

Daily Dose

Anxiety Can Happen At Any Age

It has been a busy week in my office. Many of the questions I've been answering are stress related. Why are we raising a bunch of stressed out kids?It has been a busy few days in my office lately.  I have been answering voice mails, emails, "tweets" and it is interesting to me that most of my messages are related to children with anxiety.

Why are we raising such an anxious group of children? Is it that the "gene pool" has changed or is it just societal? I really think that it is due to our society as a whole, we are on the fast track to creating the next generation of "stressed out" adults, even more so than ever, if that is even possible!! I will just walk you through my voice mails, as it really is interesting that my phone messages are from parents with children of all ages. There is the preschooler who won't get dressed in the morning for school due to a constant tummy ache. There is an elementary school child who is having problems sleeping every night, and a tween who is getting tics when she gets anxious at school. I also take care of a large number of college students and I have two patients who left college after their first semester as they were anxious and depressed while being away from home and did not go to class and therefore did not make their grades. In each case the parent is calling to ask what to do? I only wish I had all of the answers!! I will get on that proverbial "soap box" and go out on a limb and say that after practicing pediatrics for 25 years the problems that are related to behaviors in our children are much bigger issues than anything else. We have made great strides in disease prevention, but we are definitely not preventing emotional issues in our children. Being a parent and a child seems to get only more difficult each year. Was that the way it always was? Did our own parents think we were anxious and "stressed out"? I don't even think that was a word in the 60's, 70's or even 80's. Just the same way that everyone now says, "I am busy running errands", (I know I never heard my mother use that term), our kids talk about "stress" from very young ages. Do we as parents put that pressure on them from an early age? I know that my new parents feel "stressed" that their baby does not sleep through the night by two to three weeks, and say "what are we doing wrong?" Answer, nothing, infants are not supposed to sleep through the night at that early age. Don't set the bar so high so early! I have parents of toddlers who worry that their child cannot jump as high as their friend's toddler (I don't even know how high that might be, are their standards for the playground?). I must say it just goes on from there. I know we parents are supposed to worry, but I think that constant worry is creeping right into the skin of very young children and it is "causing" anxious children. Yes, some children are just born that way, but most are not. I am not saying that a little bit of worry cannot be beneficial at times. It is okay to "worry" about doing well in school, or making new friends, or misbehaving and getting punished or eventually how to get into college and "what will I do with the rest of my life". But balancing a little worry with constant anxiety is become more difficult. Most of my referrals are no longer to the orthopedic surgeons for broken bones, but rather to psychologists and psychiatrists to help children and adolescents deal with anxiety. There are even recent articles regarding the fact that there are not enough pediatric psychiatrists to care for the burgeoning needs in the pediatric population. I wish I knew the answers, but I really do think that we can change things, be it ever so slowly. Getting back to the basics of "down" time with family and friends, rather than lessons, tutors, and Kumon math for 3 year olds! How about less time on computers and phones and more time spent face to face talking. How about listening to our children rather than having them watching DVD's on the way to school or while out at dinner with the family. So many little things that we can all change may make a difference. We have to start trying something different, as what I am seeing now is not "the happy go lucky" children of years gone by. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

How To Break The Thumb Sucking Habit

I received an email via our iPhone App from a mom trying to get her son to stop sucking his thumb. The sooner you help your child break this habit, the better. I received an email via our iPhone App (do you have it?) from a mom who is trying to break her son's thumb sucking habit.  She writes "I've been trying to get him to stop for weeks and I'm failing, HELP!"

{C}

Thumb sucking is an innate reflex and can even been seen on sonograms while a baby is still in utero. It is a common means of self-soothing for infants and young children. Most children will spontaneously stop thumb sucking by two to four years of age. But, like any habit, there are those for whom it is harder to stop. In most cases children four and older only suck their thumb (or fingers) when they are tired, bored or anxious.  Very rarely do they suck their thumbs when they are engaged in activities like school, playing on the playground, or on the computer. They are often quite aware of the habit and will not suck in front of their friends, or teachers, but when relaxed at home their thumb goes straight to the mouth. If your child is still sucking their thumb after the age of four, it may be time to sit down with them to discuss strategies to stop their thumb sucking. Talk about germs (especially during cold and flu season) and come up with some sort of system to remind them when they are sucking and also to reward them for not sucking their thumb. Make fun sticker charts, and have a goal for number of days without sucking when the reward becomes even bigger. You know what motivates your child the most, a new book, or toy or trip to get ice cream. Do not punish your child for sucking and praise them for all of their hard work. Habits are hard to break! Many times thumb sucking may be curtailed by applying one of the over-the-counter products (Mavala Stop, or Orally No Bite), which are harmless liquids that taste badly. Unfortunately, many kids will get used to the unpleasant taste and continue to suck. Same goes for nail biters (I have not been successful in my own home in this area). Many children will stop their daytime sucking but continue the nighttime habit. In this case you may also try using a glove or a thumb sucking apparatus that covers the thumb and even attaches to their pajama top to keep their thumb out of their mouths. Again, you need to have a motivated child to do this or it will not work. Lastly, discuss this subject with your pediatric dentist. Sometimes, just having them discuss thumb sucking with your child will be enough to get a child to stop the habit. Power of positive thinking! One final note:  There are expensive orthodontic appliances that may be used for older children that continue to have thumb sucking problems after their permanent teeth are erupting. Persistent sucking can lead to problems with a child’s bite and jaw formation and should be addressed by the dentist and or orthodontist. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue right now!

Daily Dose

How To Soothe Back-To-School Jitters

It is not uncommon for children to be both excited as well as apprehensive about the start to a new school year.Where has the summer gone?  Do you feel like I do and think, I blinked and POW it's back to school!  There's a lot of excitement for the new school year but some are feeling a bit nervous and anxious.

It is common for children to be both excited as well as apprehensive about the start to a new school year. Being a little worried about heading back to school is normal. Whether your child is going to the same school, but concerned about their new teacher, or starting a new school, the underlying uncertainty is normal. I can remember lying in bed the night before the first day of school and being so excited that I couldn’t sleep. I was always most excited about what “new outfit” I was going to wear. My mother had of course taken me shopping weeks before for the “back-to-school” skirt and sweater, and I just couldn’t wait to get to wear my new clothes. Back-to-school jitters are normal and should be discussed several days before school begins. It is very common for a child to have anxiety and stress related to a new school. But it is also not uncommon for children to worry about little changes related to such things as new lockers, cafeteria changes, a new teacher, or new friends. Some children will complain of tummy aches and headaches with the beginning of school. I am always reminded that I rarely hear children complain of a headache or tummy ache during summer vacations. These “aches and pains” are often a manifestation of a little underlying anxiety, and seem to be a September – June phenomena. A little parental reassurance will often help relieve those aches. The best plan for dealing with back-to-school jitters is to acknowledge the anxiety and plan on how to deal with it. Make sure that your child is rested for the first day of school and they have a good breakfast to start off the day. On the way to school discuss all of the positives for the new school year. Make your goodbyes short and sweet. Let your child know you will be there at the end of the day. Do not let your child see you upset, as sometimes parents too are anxious about the first days of kindergarten, high school or even college. Those back to school pictures are memorable and you will always like looking at the pictures with everyone smiling, even if your parental heart is a little sad at letting go. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

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