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Back to School, Back to Sleep!

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

Back to School

1:30 to read

Schools around the country have opened their doors and some will be starting soon. This is the first week of school for most students in my area and parents have been busy in the last few days attending “back to school” and “meet the teacher” nights in preparation for a new school yea

So…every school has different rules, expectations and strategies for helping their students evolve into their “best” selves and as you get older the “rules” often change in hopes of making students more independent and responsible. I other words, getting ready for the “real world ‘ one day.

Catholic High School for Boys in Little Rock, Arkansas has recently been highlighted in the news and on social media for the sign that is posted on the entrance to the school. It reads “If you are dropping off your son’s forgotten lunch, books, homework, equipment etc, please TURN AROUND and exit the building”  Your son will learn to problem solve in your absence.”  The school posted the same message on their Facebook page as well.

According to the principal of the school, this has been a Catholic High rule for quite some time…it was also a rule at the high school my boys attended.  While some feel that this is unjust and that the students should be allowed to “phone home” if they have forgotten something, the school’s explanation is really fairly simple…allowing your child to have some “soft failures” and to learn both problem solving skills and responsibility will ultimately mold them into functioning members of society as they reach adulthood.  Sounds reasonable to me.

I know that as my boys went from elementary school, on to middle school and then high school their father and I had greater expectations that they needed to be responsible for getting their “stuff” to school.  We started off the school year with a game of sorts where you were given 3 “hall passes” for the year. I guess this started from something at school where they were given a hall pass to go to the bathroom or the office, and some teachers would hand out homework passes that allowed you to “skip” an assignment. So, each child ( this probably started in about 3rd or 4th grade) had 3 passes/year  where they could call and have us “rescue” them if they forgot something. Once you used up your “hall passes” you had to suffer the consequences of no lunch or turning in an assignment late.  Interestingly, each child was a bit different….one would use them up pretty quickly, another would “hoard” them for late in the year.  One wanted to know if they could be accrued? 

By the time they reached high school it was not a SHOCK when they were told the school rule that they could not call their parents.  It seems they figured out how to borrow money for lunch, or share with a friend, how to borrow a tie or jacket for an assembly and that turning in assignments a day late usually meant 10 points off. Not only did it help them become more organized and responsible, it also made me a working Mom “feel less guilt” that I really was not available to rescue them sometimes, even if I wanted to.  Do you think you would appreciate waiting in your pediatrician’s office (any longer than you may already) while they tried to run a homework assignment to school??  

You might try starting off the school year with a few hall passes and see if it works for your family!  

Daily Dose

Drinking and Driving

1.15 to read

An article released this week in the journal Pediatrics re-iterates the need for parents to discuss the risks of drinking and driving.  With spring break in full swing for students around the country and proms and graduation following soon thereafter, this study seemed timely.

In the study researchers looked at data from 10th graders over a three year period beginning in 2009.  They found that teens who rode with an impaired driver (due to either drugs or alcohol) were significantly more likely to drive while impaired, compared to those who never reported riding with an impaired driver. The study also found that the earlier and more frequently teenagers reported driving with an impaired driver, the more likely they were to drive “under the influence” themselves.  

The study only serves to confirm what one would think.....teens have to make choices and refuse to ride with friends (or adults) who have consumed alcohol (or used drugs).   It is often hard for a teen to turn down a ride with a friend who they know may have consumed alcohol (even one drink), especially if they do not have their own car or driver’s license.  

The study also showed an association between driving while impaired and obtaining a driver’s license at a young age.  Some states are not only implementing a graduated driver’s license but are taking the lead and have raised the legal driving age.  

The research presented in the study serves as a reminder that parents need to continue the dialogue about alcohol and driving.  Parents need to be clear that there is a “no tolerance” rule in the family and let their teen know that if forced with the decision to ride with a friend who is “impaired”, to call a parent to come and get them rather than getting into the friend’s car. No questions asked....just go get them.

The other serious subject is that parents may be guilty of driving while impaired as well, and a teen should not get in the car with an adult either. That includes coming home from a school event, a sporting event, or a ride after a baby sitting job.  

Make sure that you the parent are modeling behavior and do not drink and drive. How do you expect your teen to take your advice if you do not listen to your own advice.

So, sit down with your teen and continue the discussion about decisions and consequences.....they need to think about this all of the time.  

 

 

 

Daily Dose

Over-scheduling Your Kids

2.00 to read

Today is my day in our media office and we were all talking about our weekends. I soon realized how busy everyone is and that made me think about "over scheduling." Even when talking to patients, parents and my own children, it seems that weekends are not the down time we used to think about. Where did those lazy Saturdays playing in the yard or picnic in the park go?  

The weekend starts right after school on Friday with the first game of the weekend or the pre-party for the game etc. Saturday morning the alarms are still set as even your four-year old may have a early morning soccer game (do they let you start soccer and football in diapers?) at 8 a.m., and then every other sibling has at least one activity too whether it is dance, karate, or piano.

By late afternoon both parents have been carpooling, organizing and being spectators and cheerleaders, with a probable visit through a fast food line for a quick lunch.

As evening approaches everyone is already tired, but so much to do on a Saturday night too. As a parent of teens that means chaperoning, being available and always being home if your teen is going to have friends over. The other thing with teens is that they want to stay up late.  Somehow I always thought you got more sleep once you left the "parent of infant" stage, but it comes back to hit you when you are 15 years older and staying up with the teenagers and their friends. Curfews are a good thing for everyone.

Sunday is not the "day of rest" either as not only is there church and Sunday school to get to, many school aged kids have practices and games or tournaments on Sundays. My minister even gave a sermon on this subject recently. Church attendance is down as parents must get their children to their Sunday sporting events. The "day of rest" idea may be a good discussion to have with coaches.

So that lazy weekend has turned into just two more days of stuff to do....over scheduling. Take a day off for you and your family. Just wake up and say, "what would we like to do today?" Staying home and laughing while playing a board game should be one of the choices.

What are your tricks to keep your kids from being over-scheduled?  I would love your feedback.  

Daily Dose

Sans the Screen

1:30 to read

A bit of fall weather has finally arrived and with it “we” Texans can finally go back outside and enjoy some fresh air rather than the artificial (necessary luxury) air conditioning that we have lived in for the last several months. Texas has brutal summers!

So….with the cooler weather and the opening of Shake Shack in Dallas I thought it was the perfect time for a field trip (and a hamburger). My husband and I headed out for lunch only to find a long line but decided that we had time to “kill” so we decided to just hang out and wait our turn. While standing in line and then waiting for our double cheeseburgers (sometimes you just go for it! , I started looking around and noticed once again that most people were all looking down at some sort of phone screen.

There were people of all ages waiting in line and and on the lawn area but I would have to guess that greater than 80% were not engaged with anyone other than their own screen. This included children who had an iPad to pass the time, or teens and their friends, to millennials and then the “older” folks as well.  I suddenly realized that everyone is so busy scrolling through their phones and seeing what the rest of the world (or their hundreds of Facebook friends) are doing that they are not experiencing their own lives. We are living other people’s lives via a phone screen rather than being in the moment (even a boring one) of our own life.  

I was equally guilty (before I had this revelation) as I was taking a picture of the Shake Shack line to send to my children who had lived in NYC and loved the SS burgers.  I am not sure they really “cared” about the line at SS, although one replied to the text and picture with a picture of his own showing a  tray with burgers and fries…and the text, “ we have already been”. 

The whole discussion about how much time the world now spends looking at a screen or socializing via a text or email rather than a conversation continues to evolve, but experts in child development are concerned. Their concerns surround things like language development and social skills and the ability to carry on a conversation whether at home, or school or eventually at work,  as well as how to understand body language. The number of children that I now see with issues surrounding social skills and how to interact on a playground or in a class room seems to be growing and I wonder if any of this relates to electronics….call me crazy, but I really think there is a correlation.

So…at that moment as I watched those around me, I vowed to put down my own screen, record less of where I was or what I was doing (which is not necessary ) and to live in my moment…and not worry about what everyone else is doing.  My husband and I spent the next hour enjoying the weather, the hamburgers and each other’s company…sans the phone!  

Of note, I did watch one young mother corral her two precious toddlers and play hide and go seek while waiting….kuddos to her, they looked like they were having a ball.

Daily Dose

Controlling Anxiety in Kids

1.30 to read

The longer I practice the more I am concerned that our children are becoming more and more anxious at younger and younger ages.  While I was used to seeing anxious teenagers with worries about grades, standardized tests, juggling a myriad of extracurricular activities, and ultimately getting into a college, I am now seeing younger and younger anxious children worried about a linty of things.

It is not uncommon for me to be seeing an elementary school child (1st-6th grade) for their check up and when I start discussing sleep I find out that the child is scared to sleep alone, will not spend the night with friends, and has tried just “about everything” to try and fix it. There are others who are so worried about tragedies occurring in their school, or being abducted or hit by a terrible tornado or hurricane that they have constant tummy aches and headaches and don’t want to go to school or be away from their parents.

The list of what causes their anxiety seems endless, and part of this may due to the constant bombardment of news via TV, internet and other sources.  Although our world often seems large and impersonal, this constant and repetitive news stream also seems to bring every story into our own neighborhood.  This was not the case before cable, internet and the need to fill 24 hours a day with programming.  

But I digress. The anxiety issue is concerning and I find myself often thinking, “get over it”. The problem is that some of these children have tried and tried and need help to “get over it”. I also don’t think that for most children this comes in the form of a  pill. The thought of putting thousand of anxious kids on medicine really worries me. I wish I thought that the world was going to get “less scary” or be any less anxiety provoking, but I unfortunately think that our children, and my patients are going to have to be “taught” how to deal with anxiety in a stressful world.

As I tell these families, these young brains are very pliable and are really ready to learn new ways to help their brains deal with anxious and worrisome thoughts. One of the ways to address these emotions is with Cognitive Behavioral Therapy (CBT).  

Check out our new feature called “Parenting Panel”.  We have invited experts to provide expert information from their respective fields of expertise. watch for a daily dose with a guest author who will describe how CBT works.  It is fascinating and works well to help children, teens and even adults to learn “to get over it”, with a little guidance from trained professionals. 

Daily Dose

Teen Dating Violence

1:30 to read

February is Teen Dating Violence Awareness month… but this is a subject that we should be discussing year round. Relationship violence is much too frequent and the latest statistics show that more than 1 in 3 women and 1 in 4 men will be in a violent relationship in their lifetime.  Most of those will experience relationship violence between the ages of 18 - 24 years….but many of those affected said that had never been told what relationship violence looked like. 

The key to ending relationship violence is to educate teens as to the signs of an unhealthy relationship.  This means that parents need to be discussing what a healthy relationship is and what it is not, so that their child will know the difference.  

There are often many clues and warning signs that YOU are in an unhealthy relationship.  These may include having a partner who is too smothering and jealous. They may get upset if you spend time with your family or friends, and are jealous of any time spent away from them…for whatever reason.  Their jealousy may escalate where they even begin asking you to check in with them excessively via texts or phone….to make sure they “know where you are”, always. 

At the same time another sign of being too “controlling” is having your partner ask for your passwords to social media accounts.  This will enable them to go on to your sites,  even without your permission.  Not only may they use this as a way to read your texts, but they may even  change your Facebook page when they want to….more control.

Sex may be another area for concern…. They may ask you to do something that you are uncomfortable with.  They may also “force” you to have sex when they want, rather than when mutually decided.  They may even threaten to break up with you if you don’t submit.

Relationship violence may also include verbal abuse…where your partner speaks badly of you to other friends or even puts you “down” in public.  They may belittle you and shame you and embarrass you in front of your friends.  This is never appropriate. 

Teens will tell me that their partner would often say, “if you loved me….you would….”, but that is not what  real love looks or sounds like.  That statement should actually be a warning sign of a possibly unhealthy relationship that is far too controlling.  I would tell that teen to “run Toto run”…even if it seems terribly hard.  Get out of the relationship before the relationship becomes even more unhealthy and even scary.  Let your teen know that you are there to listen and help if asked.

Keep the conversation going and let them know that there is a difference between a healthy and unhealthy relationships. Remind them that they want to look for respect in a relationship.  Power and control are not love. 

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