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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

Sex On The Internet

1:30 to read

I have always felt comfortable discussing the human body and sexuality with my patients. In fact, when talking to parents about language development and how a child learns language, I often discuss playing the game “where is your eye, where is your nose?”. Over time a child learns not only to point to the body part, but will soon say the word. Quickly thereafter children ask about their other body parts and I encourage parents to call them by their correct name…penis, testicle, vagina, etc. This is easy for some parents, but some find it awkward and anxiety provoking…and need a bit of prodding as they feel uncomfortable even saying the words out loud.

So, when it comes to a child getting older and discussing puberty and developmental changes I again have some parents who say….” REALLY, do I have to discuss this” or  “can’t they just learn this at school” or “isn’t there a book they can read”?  Some others will say, “ I think my child is too young”…but their child may be 10 or 11. By this age some children I see are already starting to have  body changes, and may have wondered “what is happening to me?”.  But what I find equally interesting is that I also routinely ask their child “do you have a cell phone, computer or iPad?” and therefore many have internet access.  Now, why are the two being discussed together….? Because it seems that many kids are learning about sex and sexuality from the internet and social media, rather than from their parents.  So, not only are parents unaware that their child already “knows” more than they think, they also do not realize that their child’s idea of sex may be totally skewed and even inappropriate, depending on what website they have “stumbled upon” for information.

It seems that more and more young kids may be getting an education in pornography rather than sex and human sexuality. In many cases these young kids are “innocent” when they type the word “SEX” into the Google search….but what pops up is not.  This in fact happened to a young partner of mine who called me, her son’s pediatrician, in “horror” to tell me what she had found on her sons I-pad. “PURE PORN” I believe were the words she used.  While she and her husband had talked to him about body changes and sex before (I remember I gave her my previously well used book “Where Did I Come From”. But, being a normally curious boy ( or girl) he had gone to his iPad (which he uses with guidelines and supervision) and typed in SEX . WHOA…you should see the places he went!   When he was “discovered”,  he admitted that he was scared when he saw the pictures, as well as confused.  After a lengthy discussion about “healthy” sex and some more appropriate pictures, his iPad was put in “time-out” for awhile.

But, is this how today’s youth are going to learn and think about sex and sexual relationships….from internet porn that they have seen either intentionally or accidentally? I  expect that there are going to be more and more problems with our teens and young adults having what I would term “inappropriate sexual relationships”  if their knowledge and expectations are learned from these sites.  I don’t know how you possibly block all of this sexual information, some of which is quite inappropriate, oppressive and seemingly not consensual, from our kids.  At the minimum you need to make sure that you are having conversations about sex as your child gets older… use the appropriate terms for body parts as well as positions and types of sex … because they might be aware of a lot more than you think, and are too confused and embarrassed to ask. 

 

Your Teen

Violent Video Games Tied to Teen Agression

Adolescents who play violent video games may become increasingly aggressive over time according to research from a new study. The study of American and Japanese teenagers found that kids who played violent video games on a regular basis were more likely than their peers to become increasingly involved in physical fights.

"Basically what we found was that in all three samples, a lot of violent video game play early in a school year leads to higher levels of aggression during the school year, as measured later in the school year -- even after you control for how aggressive the kids were at the beginning of the year," said lead researcher Dr. Craig A. Anderson of Iowa State University. Researchers also point out that not all children who play aggressive video games act them out in real life. Nor is media violence alone to blame for teenagers' aggression. Another researcher in the study pointed out that what video games may do is feed the idea that violence is a normal and acceptable way to react to everyday conflicts. ""It is important to realize that violent video games do not create schools shooters," said Dr. Douglas A. Gentile. Researchers followed three groups of children ages nine to 18 years old over several months. The study is the first to show that effects are seen across cultures. It is also the first study to chart changes in gamers' aggressive behavior over time.

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Daily Dose

Kids & Cellphones

1:30 to read

There is a new study out from the National Toxicology Program in which rats were exposed to radio frequency radiation for nine hours a day for two years beginning in utero.  They compared these rats to those that were not exposed and interestingly some of the male rats developed tumors in their hearts and brains and the controls did not.

I am writing about this as another deterrent to giving children a cell phone at a young age and for not having a home phone. While it is too early to say if this study has any bearing on humans and obviously the exposure was heavier than normal, this may serve as another deterrent to giving children a cell phone at a young age. It may also help to bring “land lines” back into the home. 

Call me old school, but I continue to believe and counsel patients, having a home phone is still important.  Without a home phone how can you call your child when you are away and they may be home with a babysitter….and not depend on the caregivers cell phone?  I also think that some children may be ready to stay at home for 30 min to an hour at a time while their parents go to the store, or pick up a sibling from school etc. before they are ready for a cell phone. By having a home phone the child has a means of contacting their parents, neighbors or emergency personnel and don’t risk losing a cell phone or any of the other numerous issues associated with owning a cell phone.

A home phone also gives children an opportunity to learn how to answer a phone and begin “screening” phone calls for the family and to learn phone etiquette….which is not always taught when parents are answering the cell and handing it off to their child.  What about the days when we were taught to say “Hello, Hubbard residence” when answering the phone?  Or having your mother sit by your side while you called a friend’s house and started off the conversation with, “may I please speak to…Sally?”. Phone etiquette was such an important part of every child’s life.

Once your child does have a cell phone it also seems that they may spend more time isolated from the family when on the phone….and may spend longer amounts of time on the phone than when the phone was in the family kitchen. Even my grown children often go outside to take their cell phone call….wonder what they are talking about, me?  I digress….

The American Academy of Pediatrics continues to recommend that parents should limit the use of cell phones by children and teens. A cell phone is not a toy and emits radiation.  Keeping this source of radiation away from our children for as long as possible seems prudent while more research continues…and this study just gives parents a bit more ammunition when their 6 year old starts off with, “everyone else has a cell phone…when can I have one?”.  

 

Daily Dose

Marketing Healthy Foods to Kids

1:15 to read

The marketing of foods to children continues to be a hot topic.  As any parent knows…by the time your child is 3, 4 or 5 years old…they can often point to the box of sugary cereal with their favorite cartoon character on it, or identify a sign (McDonalds, Chic-Fil-A, Pizza) although they are not yet reading.  Companies are very clever when it comes to marketing…especially to children who drive a lot of consumer choices.

But, a recent article in Pediatrics shows how marketing may also drive healthy food choices. The study entitled, “Marketing Vegetable in Elementary School Cafeterias to Increase Uptake”, looked at the number of students who chose fresh vegetables from the salad bar at 10 elementary school cafeterias in a large school district over a six-week period.

The study included four different groups. In the first group the schools displayed vinyl banners with branded cartoon vegetable characters. These banners were then wrapped around the salad bar bases. The characters displayed “super human” strength related to eating vegetables (the Popeye of my generation - with his spinach).  The second group of schools showed short television segments which had vegetable characters delivering healthy nutritional advice. In the third group of schools both the salad bar banners and TV segments were used to promote healthy nutrition and food choices.  The fourth group was the control group and received no intervention.  The intervention schools also had decals with the vegetable characters placed on the floor which directed the children to the salad bars.

The results?  Nearly twice as many students ate vegetables from the salad bar when they were exposed to the banners.  More than 3 times as many students who were exposed to both banners and TV segments went to the salad bar (more girls than boys ). Interestingly, the marketing campaign also increased the number of students who chose a vegetable serving in the regular lunch line as well. 

So, it seems that branded marketing strategies may be used in a positive way to promote healthier food choices among young children.  Now we just have to get the advertisers to change some of their branded messaging aimed at young children from the “junk” to the healthy foods, as we have data to show that kids will choose good foods…especially if their super heroes like it too!

Daily Dose

Teach Your Kids Good Manners

1.15 to read

Spring is always a busy time of year with end of school parties, proms, graduations, and lots of invitations.  These invitations are often sent not only to parents but many times they are sent to the kids as well. Some invitations have a reply card or say “please reply” or RSVP.   

Do your kids know what RSVP means?  Although it is French, surely everyone still knows it means “reply if you please”. Has RSVP been replaced by LOL and OMG? It is a common courtesy to respond to an invitation and one that all children need to learn (maybe some adults as well). 

Over the years I have had to explain this courtesy to my own children. Sometimes they just did not understand why I bugged them to reply in a timely matter.  After looking at the bulletin board where I would put check marks and dates by our response, I would often ask them if they had replied as well? This question was often answered with, “Not yet, trying to decide, or “ They know that I am coming ” or lastly “ I’ll do it later”.  Such answers did not seem to be exactly what I had hoped to hear. Of course, I couldn’t relent until we had closure on this issue and I knew that they had responded.  I was the bothersome mother after all!

For many years they seemed clueless as to head counts and party prep. I would re-iterate that by getting an idea of how many people are going to attend any event the hosts can make sure that there are enough seats for everyone coming, or enough food to eat and drinks for all. Otherwise, you either spend way too much over buying or end of scrounging as you didn’t plan on that many people. “Whatever”, right? 

Well, now that they are older, they were just complaining to me that they had not heard from guests for a party that they were planning. “How do I know how much food to order?”, “How do you rent tables and chairs if you don’t have a head count?”  “Why do people wait till the last minute to reply?”  “Didn’t their parents bug them about replying?”  And finally, music to my ears, “Mom you should write a blog about learning to reply to invitations”! 

So...here it is. Teach your kids (beginning at early ages) how to reply to a party. Have them pick up the phone to reply to the 5 year old birthday party, or learn to write an email response when they are accepting an invitation to attend an event. Teach them to reply in a timely manner, and if something does change, let the hosts know.  Lastly, I still don’t see any reply messages that say “text me if you are coming”, but I am sure that is just around the corner.  

Good manners are ageless and timeless.

Daily Dose

ADHD Medication

1:30 to read

If your child takes medications for ADHD you may be noticing that your insurance company may be denying coverage for these prescriptions, or they are wanting to use a generic version of the medication your child may be taking.  It seems that this is becoming more and more prevalent and I get phone calls from patients asking what they should do?

Medications for ADHD have never been inexpensive and for some families, especially without insurance coverage, they are cost prohibitive.  For a child who has been diagnosed with ADHD, it is known that a combination of medication and behavior modification provides the best outcome.

When I begin a child on medication for ADHD I typically start with a brand name drug and do not use any generics.  I explain to parents that although I am a believer in generic drugs, and use them frequently, I want to make sure that any effects of the drug (positive or negative) are indeed due to medication and are not influenced by a difference in a generic drug.  Once a patient has been on medication and is doing well, if there is a generic available, I will often prescribe it in order to be more cost effective.

Over the years patients have commented to me that they do not feel as if the generic version of their given ADHD medication is working well. While these are anecdotal reports, they have not been uncommon. In that case some of my patients have opted to pay for the more expensive brand name medication.

The FDA just released an interesting article that states just that....studies have recently found that generic versions of the drug Concerta (by 2 different manufacturers) “may not provide the same therapeutic benefits for some patients” as does the branded medication.  While Concerta has a “drug releasing system” that provides 10 -12 hours of extended effectiveness, it seems that the generic drugs may relase more slowly, and the diminished release rate may not provide the same effect for the patient.

So, if your child is on these medications and you have tried a generic version and were concerned about their effectiveness, now is the time to discuss with you doctor.  This may not be the case for all, but it is certainly worth knowing there is now data on this subject.

Daily Dose

New Year New You

1:30 to read

With the New Year upon us what better time to talk about changing some habits.  Why is it that habits are certainly easy to acquire, but difficult to change?  I saw a book on The New York Times Bestseller list about “Habits” and I am committed to reading it this year.  

I know that we started many “bad” habits when my husband and I were new parents, and I talk to my patients every day about not doing the same things I did.....but, even with that knowledge there are several recurrent habits that I wish parents would try to change....or better yet, don’t start.

Here you go!

#1  Do not have your baby/child sleep with you  (unless they are sick).  This is a recurrent theme in my practice and the conversation typically starts when a parent complains that “I am not getting enough sleep, my child wakes me up all night long”.  Whether that means getting in the habit of breast feeding your child all night long, or having your two year old “refuse” to go to sleep without you...children need to be independent sleepers. Some children are born to be good sleepers while others require “learning” to sleep, but either way your child needs to know how to sleep alone. I promise you...their college roommate will one day thank you.

#2  Poor eating habits.  Family meals are a must and healthy eating starts with parents (do you see a recurrent theme?). I still have parents, with 2, 3 or 4 children who are “short order cooks” which means they make a different meal for everyone.  Who even has the time?  Sounds exhausting!!  Even cooking 2 meals (breakfast, dinner) a day for a family is hard to do for 20 years, but enabling your children to have poor eating habits by only serving “their 4 favorite foods- is setting them up for a lifetime of picky and typically unhealthy eating.  Start serving one nutritious family dinner and let everyone have one night a week to help select the meal. Beyond that, everyone eats the same thing.  Easy!  If they are hungry they will eat.

#3  No electronics in your child’s room. If you start this habit from the beginning it will be easy....if you have a TV in your child’s room when they are 6-8, good luck taking it out when they are 13-15.  First TV in their room should be in a college dorm.  For older children make sure that you are docking their electronics outside of their rooms for the night. Everyone will sleep better!

These may sound easy....so give it a try.  

Happy New Year!

 

 

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