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Daily Dose

Breaking Bad Habits

1:15 to read

Do any of your children bite their nails or suck their thumbs? If so, are you always saying, “take your fingers out of your mouth, they are dirty”, or “if you keep biting your nails you will get sick due to all of those germs on your fingers”!  I was guilty of saying those very things to my own children, and I also remember being a nail biter and my mother saying the same thing to me.

Well, who would have thought that a study just released today in the journal Pediatrics might make us parents eat our own words (it wouldn’t be the first time).  The study, “Thumb-Sucking, Nail-Biting and Atopic Sensitization, Asthma and Hay Fever” suggests that “childhood exposure to microbial organisms reduces the risk of developing allergies”.  Who knew that there might be something so positive coming from a “bad habit”.  

This study was done in New Zealand and followed over 1,000 children born between 1972-1973 (dark ages) whose parents reported that they either bit their nails or sucked their thumbs at 5,7,9 and 11 years old. The participants were then checked at ages 13 and again at 32 years old to look for an allergic reaction ( by skin prick testing) against at least one common allergen.  And guess what…at 13 years of age the prevalence of an allergic reaction was lower among those children who HAD sucked their thumbs or bitten their nails.  Incredibly the the findings persisted almost 20 years later!  This study even looked at cofounding factors including sex, parental history of allergies, pet ownership, breast feeding and parental smoking… none of which played a role. 

So, while not advocating for children to suck their thumbs or bite their nails (which unfortunately I did until high school when I decided to have nails to polish) there may be a silver lining….a protective effect against allergies that persists into adulthood. 

Lemonade out of lemons!!!

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

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

Gold Medal Madison!

1:30 to read

I often write about choosing to be a pediatrician and realizing over the years that I picked the best field of medicine. What a privilege it is to care for a young family’s precious newborn and then to watch that child grow up. While there are many long days, and countless phone calls at night I can’t imagine practicing any other specialty. 

While I saw my own children grow up all too quickly, it seems that seeing your patients on a yearly basis somehow makes time go a bit slower.  In the beginning you see the newborn and toddler quite frequently, but then your patient turns 3 and you only see them yearly (barring illness) and each year you get to talk to them about their hopes and dreams.  How often have I asked, “what do you want to be when you get older?”.  Many times their aspirations change, but sometimes you hear the same thing over and over, from very early ages.

So….this is about one of those children, who is now a young adult, who is living her dream!  Although I am not her parent,aunt or godmother, as her pediatrician I have watched her grow up with a goal. Through ups and downs, highs and lows, exhausting days of school and practice followed by more practice and even long nights in the gym and unfortunately some injuries along the way,  she has always been persistent (and resilient) in her goal of being the best gymnast she could be…. and now she is an OLYMPIAN! (I just got goosebumps as I wrote this).

You know when someone just has “IT”, well, she did!! Her parents would come in each year with her for check ups and talk about her gymnastic ability…they “wondered where it even came from”.  She was a natural…no one that I saw pushed her, or begged her to become a world class gymnast…in fact, it was almost the opposite, she had the drive and the dream. I saw her parents provide the support (emotional as well as financial I am sure….how many carpools did they have to drive?) for this little girl who knew what she wanted and could flip and flop and swing from bars and land the stunt while having fun doing it. I remember being blown away when she showed up for her 12 year old check up with a signed picture of herself after being named to the National Gymnastic Team. (I think she was the youngest member).  Each year she would come in and I would have to “prod” her to not be so humble and tell me how she was doing in the gymnastics world. I suddenly found myself following her scores in the newspaper, reading about another competition around the world or sometimes with a text from her mother with updates.  With each win I too could see her….getting closer to the goal…. ultimately winning the world uneven bars competition.

But today, as I sit here  how I wish I had gone to Rio!) getting ready to watch her begin her quest for an Olympic medal…I have butterflies in my stomach, and I can barely stand to watch… (how does a parent go through this??).  I know her mother says she cannot sit in her  seat but wanders around the venue to find just the right spot to watch her daughter compete.  I now find myself trying to decide whether to even watch…or just wait for the results. Whatever happens….Madison Kocian has already won gold in my mind! 

…and now the world knows what I have always known….Madison is a gold medalist!!!  Way to go Maddie!!!

 

Daily Dose

The Truth Behind Lies Parents Tell

1.30 to read

What an interesting study I came across recently regarding lying. Guess what, it was not about children lying, but rather about parents lying to their children. While reading the article, I must admit that I too have been guilty of some of these “tall tales” or “white lies” while parenting my own children. The study was published in the  Journal of Moral Education (there is a journal for everything!). In this article, the researchers found that while parents teach their children the importance of telling the truth, parents often resort to lying to get their children to perform tasks, or change their behavior, or even to make them happy. The mixed messages that children receive from parental “lies” may prevent a child from understanding how to navigate their own world without telling lies. Many parents reported telling lies to their children to shape their child’s behavior. Think of all of the things we say each day from, “if you don’t eat your vegetables you won’t grow taller”, to “if you don’t wear a coat you will get sick” and my favorite, “if you don’t stop crying Dr. Sue will give you a shot!” (my friends used to call me when we had young children and tell their own children this), no wonder doctors are scary. That lie never worked in my house! It is a fine line to decide when something is an out and out lie, versus being a little less than truthful, especially with young children. Teaching your children about being polite, and not hurting feelings, often requires being less than truthful. How do you explain that is inappropriate to call someone “fat” when they really might be? Same thing for telling someone you don’t like what they are wearing or how their perfume smells, we are often not truthful, but sparing the truth seems to be a lot nicer. I guess this also goes for telling “everyone” they did a good job, when one of your children made an even bigger mess while trying to clean up. But at least they tried right? Or giving everyone a prize, even though they were not all really winners. We parents often lie on the spur of the moment because it is easier than telling the truth. We often don’t think how it might affect our children in the long run. If lying is consistently used by parents, real opportunities for children to learn about the truth and sometimes the consequences that come with that knowledge, may be missed. Bottom line, we all need to think about those little white lies, and in some cases, even when it seems easier to tell a “little lie”, rethink what you are going to say. I think this is called, “thinking before you speak” and that is sometimes hard for both parents and children. What little lies (wink) do you tell your kids & why?  Share it with us and leave you comments below. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue.

Daily Dose

When Children Pull Their Own Hair

WHat can yo do if your child pulls their hair out?I received an email via our iPhone App from a mother who was concerned that her 12 year old son had started pulling out his eyelashes.  This is called trichotillomania.

Trichotillomania is an impulse control disorder which is characterized by "the excessive pulling of one’s own hair which results in hair loss.” It may be eyelashes, like this adolescent boy, or it may be hair on any other part of the body. It most commonly involves scalp hair, but eyelash and eyebrow pulling is the second most common site.  The hair pulling may result in small amounts of hair loss, which may not even be noticeable, to such excessive pulling resulting in total loss of eyelashes, brows or even baldness. Hair pulling in childhood may begin during toddler and pre-school years, where it seems to be more of a “habit” than a compulsion. In this case the hair pulling is typically short lived and resolves on its own. Hair pulling that occurs in children of older ages (peaks are seen between the ages of 5 -8 and during the teen years) is a type of obsessive compulsive disorder where the person cannot resist the behavior and of may even experience gratification when pulling out their own hair. At this point the compulsion leads to the inability to resist pulling one’s own hair, which may in turn cause more anxiety and stress, which then leads to more hair pulling and a vicious cycle occurs. At this point ,the behavior may have gone on for months and then is labeled trichotillomania. In my own experience with children who have trichotillomania, the child often tries to hide the behavior, and may even deny the hair pulling despite the fact that they have an area of baldness or even no eyebrows. They will often act is if they cannot figure out how the hair loss occurred. Parents too may not see the child  actually pulling their own hair and also are confused as to the etiology of the hair loss.  Children may experience a great deal of distress secondary to their hair pulling,  not only from the actual loss of hair, but they may also avoid school or social situations due to embarrassment. Self inflicted hair pulling is a psychiatric disorder that is often difficult to treat and requires professional help. When seeking professional help look for a psychologist or psychiatrist who has experience in this area. That's your daily dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue!

Daily Dose

Kids & Too Much TV

1:30 to read

Another recent study has just been released which confirms that children are getting close to 4 hours of background TV noise each day. While many parents are aware of the need to limit their children’s active screen time (which includes TV, video game, telephone texting and computer screens) to no more than 2 hours per day, background TV time may be equally important. The American Academy of Pediatrics also discourages any TV viewing for children under age 2 years. 

*The study from The University of Pennsylvania’s Annenberg School for Communication defines background TV as “TV that is on in the vicinity of the child that the child is not attending to”.  The research looked at TV exposure in 1,454 households with children aged 8 months-8 years. The study found that younger children and African-American kids were exposed to more background TV than other children.  Having background TV noise of any kind can disrupt mental tasks for all and may also interfere with language development in younger children. 

Those households that had the least background TV exposure were those that did not have a TV in the child’s room!! That doesn’t seem to be a surprising finding at all. Many parents leave the TV on in a child’s room to help them sleep, although there are numerous studies to show exactly the opposite effect, TV disrupts sleep. I now routinely ask every parent during their child’s check up if there is a TV in the child’s room. I also ask every older child the same question, and there are many teens who are not happy with me when I encourage their parents to take the TV out of the bedroom of their adolescent. There is just no need to have a TV in the bedroom of children of any age.  I have given up on this discussion with my college aged patients! 

While many parents are doing a good job of monitoring what their children are watching on TV, and how long they are watching, we may not be doing as well when it comes to background TV.  While older kids hear news stories or language that they needn’t be exposed to, a younger child’s language skills may be delayed due to background TV noise. 

So, the kitchen TV needn’t be on while you are making your children their breakfast before school or in the evening while eating dinner. Family dinner is one of the most important times of the day and conversation is the key. No one needs to try to talk over the TV, just turn it off! 

Lastly, keep reading those bedtime stories for children of all ages; this is key to language, and appropriate language at that. 

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

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. 

 

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.

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