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Daily Dose

The Reality of Teen Suicide

1.30 to read

I have been saddened by the recent suicide of Washington State quarterback Tyler Hilinski. It is hard for me to fathom the pain his parents are suffering at the loss of their son. There are really no words for the shock and grief that is felt on so many levels.

Unfortunately, teen suicide is not as uncommon as you might think. Each year, there are thousands of teens that commit suicide. Suicides are the 3rd leading cause of death for 15–24 year olds. In 2000, the CDC reported 1 out of 12 teens attempts suicide and up to 1 in 5 teens state that they have contemplated suicide at some point during their adolescent years. The statistics also show that the incidence of teen suicide has been increasing over the last years, which seems to correlate with the mounting pressures, both real and perceived, that our youth feel. As an adult I think "what could be that terrible to drive a teen to end their life when so much lies ahead of them?”.  But a teen’s brain is not fully developed, and as any parent with a teen knows, teenagers are often impulsive with little thought of the true consequences of their actions.

Teen suicides are usually related to depression, anxiety, confusion and the feeling that life is not worth living. An event such as a break up with a girlfriend or boyfriend, substance abuse, or failure at school may lead to suicide.

There are also gender differences among teens who commit suicide.  Teen girls are more likely to attempt suicide than teen boys. With that being said, teen boys are more likely to complete a suicide.  Girls are more likely to use an overdose of drugs to attempt suicide while boys are more likely to shoot themselves.  While a girl may use an overdose or cutting  as a “call for help”, there is often little opportunity for  intervention with a male who sustains a self inflicted gun shot or may even hang themselves.  Male suicide attempts are typically more violent and are 4 times more likely to be successful.

There are several things that parents, teachers and friends should be aware of as “warning signs” for adolescent depression and the possibility of suicide. A teen who suddenly becomes isolated, changes friends, has a change in their school attendance or grades,  has a substance abuse problem, is being bullied  or begins to make statements in reference to ending their life,  should be taken seriously. Professional help is absolutely necessary when dealing with these issues and parents should not attempt to “solve the teens problems” on their own.   

There are numerous resources available and the suicide prevention hotline at 1-800-SUICIDE is a 24 hour service. Lastly, over half of teen suicide deaths are inflicted by guns.   Firearms should not be kept in a home unless they are locked, and the key should always be in the care of a parent.  It might also be prudent not to have ammunition in the house if you do have a gun. If an impulsive, depressed teen has to go buy ammunition before attempting suicide they might be more likely have an epiphany and realize that things are not as hopeless as they think.  Any deterrent may be all that is necessary to prevent a suicide and the ensuing heartbreak for all those that knew them.

Send your question or comment to Dr. Sue.

Daily Dose

Your Child's Well Check

2.00 to read

From the moment your baby is born until you send them off to college, your child will be seeing his/her pediatrician for “well child check-ups”. These are regularly scheduled visits which occur quite frequently when you have a baby or toddler and become a yearly visit once your child is over the age of 3. The well child visit is an extremely important part of a pediatrician’s job, and is also your child’s medical home.

In fact, one of the most rewarding aspects of being a pediatrician is having the privilege to observe a child from birth through their teens, in a sense, “helping to raise them”. Therein lays the reason for check-ups.

When you see your pediatrician for a check-up, I’m sure you get your child’s weight, height, BMI, (and blood pressure once they are older), as well as their growth percentiles.

The doctor also does a physical exam on your child, which is hopefully all normal. But there is a lot more than that to your visit. This is the time for your doctor to discuss your child’s milestones; whether that is sitting up for the first time, first words or how they are performing in first grade.  These conversations continue for all of your child’s school years as well.

It is also the time to discuss multiple other topics which should include sleep habits, nutrition and safety which is pertinent to all age groups. As your child gets older the conversation should include discussions about school performance, bullying, studying, screen time, family meals, exercise, and the child’s interests.

For the teen patient I think it is important to discuss sexuality, peer pressures, driving, and the adolescent’s long term goals.  The list goes on and on, but certain topics should certainly be yearly discussions which are then tailored to the age of the child.

 As a child gets older it is important to have some time where the doctor may be alone with the adolescent who may want some “private time” with the doctor. It is equally important that the exam includes time spent with the both the parent and the adolescent to wrap up the check up and answer any questions that a parent may have had that their adolescent did not.

For my patients 18 and older, I find that many times their parents do not come for their check-ups as the relationship has now become a bit more about a young adult with their doctor. Everyone is different and there is not a “right” way to handle the adolescent, but it is more important to have an open rapport and conversation between patient and doctor.

Lastly, every check-up should have time for questions. It is helpful if parents have a list of questions ready for the doctor.  Young parents often have simple questions as they are new parents. So, they often start off with “I think this is a stupid question…” but, there is not a “dumb” question as they have never been parents before.  For parents with older children the questions are often more lengthy and may even require another visit or phone call to follow-up or complete the conversation.  In either case, the check-up is the place for questions.

I really enjoy my patient’s check-ups and continue to realize the importance of the well child exam and the doctor-patient relationship. Don’t miss them.

That’s your daily dose for today.  We’ll chat again tomorrow.

Daily Dose

Over-scheduling Your Kids

1:30 to read

Are your kids busy with activites this weekend?  Is your child going to be over or under scheduled?  It is sometimes difficult to find a happy medium.

 

I am still a big believer in the “one sport” per season rule and one other activity..maybe two if the third activity does not require a weekend game or practice.  So, what does this look like for a child in elementary school….soccer, fall baseball or football for the fall season, as well as girl scouts, boy scouts, debate team, chess team, and then maybe piano or flute lessons?  You can change that up in anyway and substitute dance, gymnastics, volleyball, a foreign language class…but you get the picture. In this way your child should have several days a week with “NOTHING” to do after school…except go outside and play!  This gives the parent or caregiver a break as well from driving all around to transport to the venue for the practice or game.

 

I hear so many complaints from parents who are in a constant state of stress from trying to figure out transportation for their child to the soccer practice that conflicts with the football practice and the lacrosse practice. This also requires trying to  juggle the multiple games on the weekend that go on for hours one after the next, and even on Sunday mornings.  When I hear the parents complain about this ridiculous schedule I am also seeing the children who are over tired, burnt out and may even have stomach aches and headaches due to the stress of being over scheduled.

 

While every parent is well intended and wanting their child to have as many opportunities as possible in both athletic and other extracurricular activities, a parent also needs to sometimes say “no”.  Discussing the logistics as well as the time commitment for each activity, in an age appropriate manner, may help a family decide which activity stays and which one is “punted”.

 

So….sit down before you and your child are overwhelmed and pick the activities that you will do this fall…but leave some room for being bored. Boredom is a noun that we need to hear more often.

 

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

Your Kids Need Protein!

1:30 to read

Nutrition and healthy eating habits are always a topic of discussion during my patient’s check-ups.  Interestingly, I hear many tweens and teens tell me, “I am now a vegetarian”.  While I am thrilled that my patients are developing an awareness about their nutrition, I am equally amazed by what they think a vegetarian diet is.

Many a parent has cornered me before their child’s check up concerned about their child’s recent announcement that they are vegetarians and it has actually caused some heated family discussions surrounding nutrition and dietary requirements. The parents say that their child just decided that they no longer wanted to “eat meat” and that they were vegetarians. 

So…many of these new “vegetarians” don’t even like vegetables, and a few are confused by the difference between a vegetable and a fruit. When I ask them if they eat broccoli, cauliflower, green beans, asparagus, eggplant and potatoes, I find that more than a few turn their noses up at most of those suggestions and simply eat potatoes as their vegetable of preference. They also eat avocados, and are surprised to find out that it is a fruit, but it is a good source of healthy mono unsaturated fats.  A few are a bit more adventuresome and actually eat a wide variety of vegetables including lentils and black beans as a source of protein.  

The same thing goes for fruits although for the most part they do admit to having a broader palate when it comes to fruits that they will eat.  Apples, bananas, berries, grapes are all favorites and many of these kids will eat fruit all day long.  Fruit is healthy for sure, but also contains sugars (far preferable to the sugar in the M & M’s I am eating while writing). 

The biggest problem with their “vegetarian diet”?   They just eat carbs! So I have coined the term “carbohydratarian” to describe them. Most of these patients are female and they eat carbs all day long.  They have cereal, toast, bagels for breakfast, followed by grilled cheese, french fries or a quesadilla for lunch and then dinner is pizza or pasta, and maybe a salad (lettuce only).  They like crackers, bread and almost all pasta (rarely whole wheat ). Rice is another favorite.

I too could probably eat a lot of these carbs every day….I think many people enjoy their carbs. But these kids are not meeting many of their nutritional requirements. They are getting very little protein! They are also growing…some at their most rapid rate during puberty. When I talk about adding protein to their diet they are often reticent to add eggs, fish or beans to their food choices. 

If your child decides that they want to change their lifestyle and might consider becoming a vegetarian or vegan, I would encourage you to have them meet with a certified nutritionist to explore their likes and dislikes as well as to educate them as to their nutritional needs.

I must say…..very few of these patients have maintained their vegetarian lifestyle, but if they choose to, they need to know the difference between a fruit and a veggie!

 

Parenting

Kids Benefit With Older Moms

2:00

Many women are waiting till they are older to have their first child, but their offspring may be the one that reaps the most benefit, according to a new study from Denmark.

Older mothers are less likely to scold or punish their young children, and those children tend to have fewer behavioral, social and emotional problems, the study suggests.

According to researchers from Aarhus University in Denmark, older moms tend to have more stable relationships, are more educated, and have more wealth and resources.

"We know that people become more mentally flexible with age, are more tolerant of other people and thrive better emotionally themselves," researcher Dion Sommer said in a university news release.

One theory as to why older mothers may make better parents is that they tend to be more psychologically mature.

Sommer noted, “that may explain why older mothers do not scold and physically discipline their children as much."

This type of upbringing may contribute to a more positive environment to grow up in.

In the study, the investigators looked at data from a random sample of just over 4,700 Danish mothers.

Among their findings: older moms generally resorted less to verbal and physical punishment than younger moms did — though those findings did get a little wobbly at the 15-year point.

The children of older mothers also had fewer behavioral, social and emotional problems than kids of younger mothers, at least at the 7- and 11-year-old points, while adolescence again seemed to muddy things up. The study controlled for factors like income and education, and attributed the results mostly to the greater patience and steadiness that comes to adults as they age.

Other studies, pointed out in a TIME Health article, have shown benefits for older moms, including:

Older moms live longer: react-text: 234 According to a 2016 study, of 28,000 U.S. women, those who had their first child after age 25 were 11% likelier to live to age 90 than those who became mothers younger. A 2014 study took this even further, finding that women who gave birth after age 33 were 50% likelier to live to age 95 than women who had their last child when they were 29 or younger. One caveat — and it’s a big one: the cause-and-effect still has not been determined, so it’s possible the older moms were simply healthier to begin with.

Their kids are taller and smarter. According to a 2016 study published in Population and Development Review. The investigators surveyed 1.5 million men and women in Sweden and found that those born to older mothers were more physically fit, had better grades when they were in school and had at least a small height advantage over people born to younger mothers. Again, causation was uncertain, allowing for the possibility that mothers who started off healthier and were able to have kids later may have simply passed those robust genes onto their children. Demographics — especially regarding income and education — may have also been at work. Wealthier moms with higher power jobs are likelier to have the financial flexibility to delay childbearing, bringing them into the cohort of older moms. More money can also mean better nutrition. Still, 1.5 million is an impressive sample group.

Older moms have more energy than you’d think: A study of mothers who had babies via egg donation after age 50 — well and truly beyond the point at which most women consider conceiving — found that they had levels of energy and physical function similar to women who had babies in their 30s and 40s.

So there you have it, women who are considering waiting a little while to start a family can do as well or better than younger women raising children, depending on their general health and outlook.

Many experts advise women not to wait too long to have children, due to declining fertility and increased risk of problems such as miscarriage, preterm birth and birth defects.

"However, when estimating the consequences of the rising maternal age, it's important to consider both the physical and psychosocial pros and cons," Sommer said.

The Denmark study was published recently in the European Journal of Developmental Psychology.

Story sources: Robert Preidt, HealthDay reporter, http://www.webmd.com/parenting/news/20170323/older-mothers-may-raise-better-behaved-kids-study-suggests

Jeffrey Kluger, http://time.com/4709403/older-mother-benefits/

 

Daily Dose

Toddler Behavior

1.30 to read

Do you have a toddler? If so you are in the throes of some difficult, albeit sometimes funny, yet inappropriate behavior. It happens to every parent...suddenly their precious child turns into Dr. Jekyll and Mr. Hyde.  Somewhere around 15-18 months, you will most likely see this change in behavior. Although most books refer to the “terrible twos” I really think it is the “me no wanna” 18-30 month old. 

“Me no wanna” is the phrase we often used around our house, and it was coined when the boys were toddlers. It just seemed like the best line when our sweet toddler would rather have a tantrum than do the simple task that we wanted him to do. Example: please put your toy back in the box. “Me no wanna”, I would prefer to fall to the floor and scream.   

How is it that your typically sweet 20 month old child can be in middle of playing nicely and then suddenly seems possessed as they fling themselves to the floor kicking and screaming?  What is the matter?  Are they having a seizure? Or is it that “something” just didn’t seem right to them and they are angry and frustrated???  How can they change behavior so quickly.?   (hint, foreshadowing for those teen years). 

You never know with a toddler what kind of answer you will get when you say something as easy as “let’s get on your shoes to go outside”. Sometimes they happily run get the shoes, bring them to you, sit down and the shoes go on licitly split.  The next time they get the shoes, throw them across the room, lay on the floor and look at you like “me no wanna”. 

Trust me, you are not a “bad” parent, you are just living through some really challenging parenting. It is exhausting at times, but while this age is typically difficult it is some of your most important parenting. This is really the beginning of behavior modification.  Your brilliant toddler is testing you, this may be the first time you the parents understand why everyone talks about boundaries and consequences. 

Some children also express their “me no wanna” by acting out with hitting, biting and kicking. Again, very inappropriate behavior. Your job is to change that behavior by using time out, or taking away a toy or even putting the child to bed early.. There are so many ways to start letting your toddler know that there are consequences for misbehaving, and that tantrums don’t work. 

I am in throes of “me no wanna” again, only this time it is with a puppy! Seems very similar to me.

Daily Dose

Bullying

1:30 to read

The incidence of bullying continues to rise even 1 month into the school year. While excitement and a bit of anxiety are typical emotions for children as they find out their new classes and teachers, there are a group of students who have tremendous anxiety about going back to school….those children who have been victims of bullying.

 

It depends which study you read but somewhere between 10-29% of students report having been bullied. This represents around 13 million kids.  Some studies also show that somewhere around 6-10% of school aged children may be chronic victims of bullying.  No matter the number or statistic, bullying is an ongoing problem among school aged children and may have long last effects on both the child who has bullied as well as for the child who was bullied. 

 

Bullying by definition is “unwanted aggressive behavior among school aged children that involves either a real or perceived power imbalance”. Bullying behaviors are also typically repetitive. Boys are more likely to be bullies and may bully boys or girls while girls tend to bully other girls more often. 

 

There are different types of bullying. It may be physical (not as common), verbal, exclusionary, or cyberbullying.  All of these types of bully behaviors cause psychological and/or physical distress for the victims.  Victims of bullying are more likely to miss school and will have absences for “unknown” reasons where they may just report “not feeling well”.  These children  may often have frequent headaches and stomach aches without any physical findings.  I find that in many cases of bullying a child has been “well all summer” and the physical distress returns once school resumes. Victims of bullying also report difficulty in school with focus and concentration as well as depression and isolation.

 

The majority of bullying takes place at school, especially at times when there may be less supervision by teachers…during recess, lunch time,  bathroom breaks, and on playgrounds.  Unfortunately with the advent of cyberbullying and the use of cell phones, tablets and computers to send mean texts or emails more and more bullying may be occurring outside of school. 

 

Just as teachers need to be aware of bullying at school, parents need to know what their children are doing online. Now is another good time to discuss or re-visit the issue of online bullying and review your own family rules for posting or texting, reminding your child that anything they post may be seen by anyone. Don’t post or send anything to anyone that could hurt or embarrass themselves or others. It just takes one person forwarding a message for it to become “viral” and it will remain in that “mysterious cloud” forever!

 

Prevention of bullying requires that students, teachers, administrators and parents all work together.  Encourage your child to report any bullying behavior or concerns that they have and to get the school year off to a good start. 

 

One last statistic: parents who are involved with their children (including their online lives) and have clear and concise rules are less likely to have children who are either those who bully or are victims of bullying.  

 

  

Daily Dose

Omega-3 Fatty Acids

1:30 to read

Many of the patients that I see who have problems with attention and focus as well as other behavioral and learning issues have been started on all sorts of different medications. For some children their medications seem to be “working well”. But, for some children it has been difficult to find the “right” medication to alleviate all of their symptoms.  Studies have shown that anywhere from 10%- 30% of children with ADHD do not respond favorably to stimulant medications. Therefore,  it is not uncommon for their parents to inquire about the use of alternative or complementary medications. In several cases their parents have already started “dietary supplements”, which at times they are reluctant to admit to, or ask for my opinion.  

Interestingly, there is recent data regarding dietary supplements that parents and pediatricians should be paying attention to…and open to discussing.  A study that was presented last fall at the American Academy of Child and Adolescent Psychiatry showed that omega-3’s “could augment the response in children aged 7-14 years who were receiving psychotherapy for depression and bipolar disorders”. There have been  studies as well that have shown “significant improvements with Omega-3’s relative to placebo for problems including aggression as well as depression and anxiety symptoms”.  There are also numerous studies looking at ADHD symptom improvement in those using Omega-3’s, and again the results have been mixed, made even more difficult by the fact that ADHD is a subjective diagnosis.  

Another issue that requires more study is how these fatty acids actually work within the body and brain. Omega-3’s are an important building block of the brain and it is present in the brain's cell membranes, where it is thought to facilitate the transmission of neural signals.  Current thought is that these fatty acids may change the cell membrane fluidity and may also have anti-inflammatory effects….but a lot of research continues on the issue of mechanism of action. 

Several of the studies looked at dosage of the Omega 3 fatty acid supplements and “it seemed that there were more positive trials related to higher daily doses of  certain omega 3 fatty acids including eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA).  There need to be further studies to address the amount and ratio of these Omega-3’s as they are used for supplements. 

So while the research continues as to the effectiveness of Omega 3’s on focus, mood, behavior and learning it is important for all children to consume enough Omega-3 fatty acids in their diet. Eating fatty fish a few times a week would be beneficial for the health of all children - and the decision to supplement beyond that may be a topic for discussion with your own physician. 

 

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What every parent needs to know about teen suicide.

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