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Daily Dose

Separation Anxiety

1.45 to read

I received an email from a mother who was concerned because her toddler son was crying when they left him at day care.  They were “alarmed” as he had not previously cried when they dropped him off and wondered if this was “normal” or a sign of a problem. Actually, this phenomenon should be quite reassuring to a parent as this is a sign that your child is developmentally on track, and has developed a healthy attachment to his parents. 

All children go through periods developmentally when they are more prone to separation anxiety.  As a new parent you are often concerned about “leaving” your child under the care of someone other than a parent. But, in actuality, it is far easier to leave a newborn or an infant than it is to leave a 8-9 month old.

By the time a child reaches this age they are beginning to show signs of stranger anxiety. In other words, they now recognize the faces and voices of their parents, routine caregivers, siblings etc.

But, when a new person (and face) reaches out for a 9 month old it is not uncommon for that child to suddenly panic and burst into tears. This is not because the “stranger” has done anything at all, but because the child now understands being separated from their parent and may fear that the parent is leaving forever. 

The bond between parent and child has been successfully established, which is quite healthy. This is the beginning of teaching a child that a parent may leave for work, school or even a trip, but that they will return.  Just because a parent leaves for awhile, they are not gone forever. 

This first stage of separation anxiety can provoke feelings of anxiousness in both child and parent, but it is an essential part of normal development. Separation anxiety, like almost all behaviors, varies from child to child. While some childen are more clingy than others, some may just be “wired” in a certain way and are more vulnerable to separating from a parent. Regardless, it is important for a child to begin to deal with healthy separation. 

During the ages of 12 – 24 months separation anxiety seems to peak, and the period of crying or anxiety when a parent drops a child at day care or Sunday school, or even at a grandparents house may escalate. 

While a child may cry after being dropped off, most children will then calm down and may be distracted and will begin playing soon after the parent has left. Again, some children just seem to take longer to adjust, so don’t be alarmed if  one child cries for 2 minutes, while another may take up to 20-30 minutes to settle down. 

Toddlers do not understand the concept of time, and therefore each one may react differently.  While happily playing while the parent is gone, it is not uncommon for the child to cry again upon seeing their parent when being picked up.  For the toddler, the return of the parent may remind them of how they felt when the parent left earlier in the day. 

For most children separation anxiety decreases between 2 -4 years of age as you can explain, and a child can understand, where you are going, how long you will be gone etc. 

For children who have rarely been left with others, it may be more difficult at this age.  Remember, healthy separations are important for both parent and child, and the idea that no one will “babysit” or care for your child other than a parent is not realistic nor does it teach your child to build trust in others. 

The more experience a child has had with earlier normal periods of separation the easier different transitions will be.  Remember, they will all be going to school one day and you want to prepare them for that separation.

Lastly, every child has good days and bad days and almost every child will have a phase when it is harder to separate than others. Just remember to hang in there, be re-assuring to your child when you leave them, do not prolong the departure, and be understanding about their anxiety. As with so many experiences in parenting, “this too shall pass”. 

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

Daily Dose

Preschool Nutrition Can Be Challenging

1.30 to read

Does your child eat three meals a day with healthy snacks along the way? I often find myself talking to parents about establishing healthy eating habits especially when you have a preschooler. Preschool children, specifically the two to five-year-old set are notoriously picky eaters, and parents need to recognize that this is developmentally appropriate, although frustrating for parents.

This is an appropriate time to begin teaching children the importance of healthy eating habits to encourage a lifetime of good health and prevent obesity. A good place to start to get information is “MyPyramid for Preschoolers”, a website sponsored by the U.S. Department of Agriculture. This website not only covers what your children should be eating, but also is full of good advice on handling picky eaters, how to monitor your child’s growth and ideas to encourage physical activity.

The website encourages parents to lead by example and let your children see you eating a wide array of foods including fruits, vegetables, and whole grains throughout the day. There are ideas for healthy snacks that can be eaten on the run, as you get back into carpools and after school activities. Even the toddler set is busy after school!

Remember: do not let food choices become a battle or an issue. Do not make negative food comments around your children, and keep trying new things. It may take up to 20 attempts or more before your child will try something new, but if you don’t keep trying you will never know if they might really like broccoli.

Also, no “yucky faces” for the adults and older children while at the table and eating their meal. That will only discourage your toddler from trying unfamiliar foods. Put on that happy face, even if it is not your favorite food, it might be your child’s.

The most important message is to make mealtime and snack time pleasant and healthy. Even a toddler can help with planning and preparing a meal. This website is really quite good and interactive as you can enter your child’s first name, age, gender and typical amount of activity and the site will generate a plan just for your child! Can’t be easier than that.

That’s your daily dose, we’ll chat again tomorrow.

 
Your Child

New Guidelines for Tonsillectomies

Most children who get repeated throat infections probably don’t need surgery to remove their tonsils and would improve in time with careful monitoring, according to new clinical guidelines on tonsillectomies in children.

The new guidelines also suggest, however, that removal of the tonsils, or tonsillectomy, may improve problems tied to poor sleep, including bed-wetting, slow growth, hyperactive behavior, and poor school performance. In fact, sleep-disordered breathing -- a set or problems that range from snoring to obstructive sleep apnea - is now the most common reason for tonsil removal in kids younger than 15. “We used to think that only if you were an air traffic controller did it matter if you slept well or not, and now we know that’s not the case,” says Amelia F. Drake, MD, chief of the division of pediatric otolaryngology at the University of North Carolina School of Medicine in Chapel Hill. More than half a million tonsillectomies are performed each year on children in the U.S., making it the second most common surgery in this age group, just behind procedures to place tubes in the ears to relieve recurrent ear infections. Despite the fact that it is a mainstay of American medicine, experts have long disagreed about how useful or appropriate tonsillectomies may be. The new guidelines, published Monday by the American Academy of Otolaryngology - Head and Neck Surgery, are the first set of official recommendations on tonsillectomy published in the U.S. The guidelines aim to give doctors and parents more information about when tonsillectomy may be warranted and to help minimize the risks and pain of this procedure in young patients. “I thought they were very comprehensive,” says Drake, who reviewed the new recommendations but was not involved in drafting them. “This is an area where improvements and refinements can have a huge impact. This is medicine at its core.” New Criteria for Removing Tonsils The guidelines update a set of clinical indicators for tonsillectomies published in 2000 by the American Academy of Otolaryngology, which suggested that doctors could consider taking out the tonsils if a child had at least three cases of swollen and infected tonsils in a year. The new guideline, however, says that kids should have at least seven episodes of throat infection, such as tonsillitis or strep throat in a year, or at least five episodes each year for two years, or three episodes annually for three years, before they become candidates for surgery, and that those infections should be documented by a doctor, rather than just reported by parents. The idea, experts said, was to reserve surgery only for the most severely affected, because the surgery can rarely have serious complications including infections and serious bleeding. “Children who have fewer episodes really aren’t going to see a lot of benefit,” says Jack L. Paradise, MD, professor emeritus of pediatrics at the University of Pittsburgh School of Medicine. “There aren’t many kids, overall, who meet those stringent criteria,” Paradise says. What’s more, Paradise, and other experts stress, that even children who satisfy the guidelines shouldn’t get an automatic green light for surgery. “I’m not sure, if I had a child that met all the criteria, that I’d automatically subject the child to the consequences of that,” Paradise says, “Post-operatively, it’s a very painful procedure.” The tonsils are cone-shaped lumps of tissue embedded in the throat, and they are believed to play a role in how the body responds to infections, though experts aren’t exactly sure how. But in the early part of the 20th century, the tonsils were blamed as the “focus of infection” in the body, and doctors began taking them out as a way to promote good health. The operation became so common for example, that entire classrooms of youngsters would get their tonsils taken out at school. But by the 1970s, many experts were questioning how effective and appropriate it was to subject kids to a painful operation that could have rare but serious complications; all for what new research suggested were minimal improvements in the risk of sore throats. At the same time, however, doctors were starting to become more aware of the myriad problems tied to sleep disordered breathing in children, a spectrum of problems that can range from snoring to obstructive sleep apnea. And more tonsils began to be taken out as a way to open up the airway and improve sleep. Improvement in Care for Kids Having Surgery Several of the guidelines suggest ways doctors and parents can improve the care of children having tonsillectomies. One of the strongest recommendations is against the use of antibiotics just before or just after surgery. “They are commonly given, and there’s no evidence that antibiotics offer any benefit,” says study researcher Reginald F. Baugh, MD, professor and chief of otolaryngology at the University of Toledo Medical Center in Ohio. “You run the risk of allergic reactions and there are the harms of over-prescribing.” In drafting the statement that advises doctors to counsel parents about the importance of pain management in kids after surgery, Baugh says the panel that reviewed the evidence behind the guidelines was alarmed to learn that many parents don’t give medications to control pain after the procedure. “That was one thing we really learned, about the importance of telling parents about the need to give pain meds in these kids,” Baugh says.

Daily Dose

Pain When Going to the Bathroom

1.30 to read

I was on call the other evening and working late in the office and happened to see several little girls (between the ages of 4-10) who all had the complaint of “it stings when I pee-pee”, otherwise known as pain with urination or dysuria. Interestingly, one of the patients had only complained several times that day, while the other little girl had a long, yet intermittent history of pain with urination.  

Whenever you hear pain with urination most parents will think of a urinary tract infection (UTI) Urinary tract infections are fairly common in this age group (about 5% of pre-pubertal girls will get one), but even more common than a UTI, is vaginal irritation that causes pain with urination as the urethra  becomes inflamed.   

Little girls love bubble baths and all of those lovely scented soaps and potions for the bath. They also love to sit in the soapy water and play or wash their hair and rinse all of that shampoo into the bath tub as well. Because the female urethra is short it is easily irritated by the chemicals and then gets inflamed. The next thing you know your little girl is complaining of pain when she heads to the potty. 

If your daughter simply has some pain with urination and is otherwise well, no fever, no blood in the urine etc. and she has been guilty of taking frequent bubble baths, you might try stopping the bubbles and see if the pain goes away. In many cases of little girl with painful urination, simply stopping the baths solves the problem. If the pain is due to soap and bubbles, these little girls typically do not have accidents or night time awakening either. Pushing fluids also helps. 

I also recommend to older girls taking showers as this typically solves the problem as well. Girls love bubbles but it’s the boys who can tolerate bubble baths due to their different anatomy! 

If stopping bubbles doesn’t do the trick you will need to see your pediatrician to rule out an infection. Remember, this type of pain with urination is often intermittent and does NOT cause fever or blood in the urine. Any of those symptoms in a child is a call to your pediatrician to be seen. 

Daily Dose

Start Good Homework Routines Now

Now that school has started homework has too. For most children homework starts in first grade and continues through out high school. There are often lots of complaints and frustrations about getting homework completed, both from the children and their parents. Like so many things, the best way to begin the school year is with a good plan for getting homework completed.

It is also easier to start younger children with good study habits that will then be maintained throughout their school years. With that being said, do not throw in the towel if you have an older child who still needs a little coaxing and guidance on getting homework done. It is never too late to make changes for the better! To begin with homework needs to be a child’s responsibility. Parents are important helpers with homework, but should not be the doers of the homework. Everyone is a little different as to when homework should be completed. For some it is easiest to come straight home from school and start homework. For others they need some “down time” and may need to run around outside to get rid of some energy before starting homework. You know your child the best, but either way, having a routine to getting homework started is the key to getting it completed. Secondly, good study habits require a good study area. Buying an inexpensive desk to set up a quiet study area will be useful for many years. Setting up this area can be fun for children too and teach responsibility for taking care of their study area. As children get older they will be used to getting their study area organized and this will carry them all of the way through college. Teachers have set expectations for homework, and are a valuable resource in helping you as a parent to know what to expect for the year. Some teachers assign more importance to homework than others; so it is important know this early in the year. Review these expectations with your child too, so that everyone is on the same page. Homework can also be a good time to watch your child at work. This is the only time that you really have a chance to observe how your child is learning. Does it seem that they have a harder time in one area than another? Are there problems with comprehension, or focus? These parental observations are important if there seem to be consistent issues, and if so make an appointment with your child’s teacher to discuss your concerns. Again, doing the homework for them will not correct the issue and tackling learning problems is better at an earlier age. By following good homework basics your child should become independent with their homework and be on the road to a lifetime of good study habits. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

The Importance of a Healthy Lunch

2.00 to read

Now that our school-aged children have gotten back to class it is a great time to discuss school lunches. I like to ask my patients and their parents about their school lunches. It is interesting to hear what kids like to eat for lunch. Of course like so many things, there is a huge amount of variability surrounding school lunch choices.

It seems that elementary school aged children enjoy buying school lunch especially when the cafeteria experience is novel. But because the choices are typically not as plentiful in the elementary school cafeteria, some children will choose to the take their lunch. The one thing that I find to be most typical is that the pizza and chicken nugget lunch days are a lot more popular than grilled chicken and vegetable days. Unfortunately, school lunches are not typically the most “healthy” and are often loaded with fats. By the time children reach middle school and high school the cafeteria becomes more of a smorgasbord of choices and the “hot lunch” tray is not the only choice available. With the vast array of choices from salads, to sandwiches and many snack items, I often hear that the “tween” and teen set pick and choose their favorite foods and fall far short of anything that resembles a well balanced lunch. The combination of a hamburger and fries, or a bagel and yogurt may be the chosen lunch items. I rarely hear milk as the beverage of choice. By the time teens their junior and senior year in high school many campuses allow their students to have “off campus” lunches. In this case the “fast food world” awaits them around every corner. It is not unusual for this age group to enjoy a “super sized” combo meal and a large Coke. Most of the girls I see opt for a “diet” Coke to round out the meal. Probably not what most parents would consider a healthy lunch. The word fruit is rarely mentioned. To start teaching children about healthy eating habits we need to begin in early elementary school. Sit down with your child and the school lunch menu and look over the choices. It might make sense to “make a deal” that they may buy their lunch two days a week and you will pack them a lunch on the other three days. They can put stars or check marks on the days that they want to buy. When packing a lunch let your child be involved, while at the same time guiding their choices. The prepackaged pizza and lunchables are not good choices. Choose whole grain breads for the sandwich. Use lean sandwich meats. Add some cheese for some added calcium. Peanut, almond or cashew butter provides protein too. Cut up veggies in clever ways to make them more appealing. Chips may be baked and put them in your own sandwich bag. There are many great ways to pack and delicious and healthy lunch, and it is probably cheaper too! That’s your daily dose, we’ll chat again tomorrow.

Your Child

Playing With Food May Help Picky Eaters

2:00

If your child is a picky eater, encouraging them to play with their food may help them overcome the reluctance to try new foods according to a new study.

Researchers in the United Kingdom asked a group of 70 children – ages 2 to 5 – to play with mushy, slimy food while their parents observed, watching to see if kids would happily use their hands to search for a toy soldier buried at the bottom of a bowl of mashed potatoes or jelly. Children who wouldn't use their hands were offered a spoon.

Parents and researchers each rated how happy the kids were to get their hands dirty on a scale of one to five, with a higher number indicating more enjoyment. Children could get a total score as high as 20, a tally of the scores from researchers and parents for play with both the mashed potatoes and the jelly.

Researchers also gave parents a questionnaire to assess children's so-called tactile sensitivity, quizzing them about things like whether kids disliked going barefoot in the sand and grass or avoided getting messy.

The study found that kids who liked playing with their food were less likely to have food neophobia (the fear of trying something new) or tactile sensitivity.

"Although this is just an association, the implication is that getting children to play with messy substances may help their food acceptance," lead study author Helen Coulthard, a psychology researcher at De Montfort University in Leicester, U.K., told Reuters Health by email.

Previous research has linked food neophobia to limited fruit and vegetable consumption. Courtland and her team wanted to see if they could establish a link between touching food and tasting unfamiliar foods.

Courtland suggested that parents of picky eaters begin introducing new foods to their child by creating “food art.” Food art is making pictures or images with different foods on a plate.  The first step is letting your child make a picture or design by arranging various colored foods on the plate.  Don’t pressure them to taste their creation, but wait till they are ready to give it a try. Make it a game and eventually begin encouraging them to taste what they have created. Start small and expand to larger food groups and pictures.

Offering as much variety as possible from a young age also helps children experience lots of textures and flavors, which may minimize their fear of unfamiliar foods.

You’re probably going to have to join in on the taste experimentation to show how good these food pictures taste! You might also take a picture of your child with their creation on your phone and then show it to them – to make it a little more fun.

It’s fairly normal for kids to go through a period of refusing to try new foods, though most kids will grow out of this phase by the time they start school. However, there are some children that carry new food aversion on into adulthood. It isn't necessarily harmful as long as the children maintain a healthy weight for their height, pediatricians say.

But over time, neophobia can make it very difficult to enjoy social engagements. Parents that have a hard time trying or enjoying new foods themselves too often pass that trait onto their own children.  Most of the time it’s just a phase that kids go through and finding creative ways to help them work through it eliminates the problem.

Source: Lisa Rapaport, http://www.reuters.com/article/2015/05/19/us-food-fears-children-idUSKBN0O41MD20150519

 

 

 

Your Baby

No Link Between Vaccines and Autism

1.30 to read

A new study slated to appear in the Journal of Pediatrics, says that there is no association between the amount of vaccines a young child receives and autism. Some parents have worried that there may be a link and have opted out of having their child vaccinated or reduced the number of vaccines recommended.

The percentage of children diagnosed with autism spectrum disorder (ASD) has increased by 72% since 2007. Some experts believe that changes in the diagnostic criteria may account for some of the increase as well as better screening tools and rating scales.

According to a statement released from the journal, researchers from the Centers for Disease Control and Prevention and Abt Associates analyzed data from children with and without ASD.

Researchers examined each child's cumulative exposure to antigens, the substances in vaccines that cause the body's immune system to produce antibodies to fight disease, and the maximum number of antigens each child received in a single day of vaccination, the journal's statement said.

The antigen totals were the same for children with and without ASD, researchers found.

Scientists believe genetics play a fundamental role in the risk for a child developing autism (80-90%), but recent studies also suggests that the father’s age at the time of conception may also be a contributor by increasing risks for genetic mistakes in the sperm that could be passed along to offspring.

Parents have worried about a link between vaccines and autism for decades despite the growing body of scientific evidence disproving such an association.

Source: Luciana Lopez, http://www.reuters.com/article/2013/03/29/us-usa-health-autism-idUSBRE92S0GO20130329

Daily Dose

Childhood Obesity

1.30 to read

Everyone knows that obesity is on the rise and it is often beginning in childhood.  During well-child visits (and often during a visit for colds or flu) parents often bring up a child’s weight.  By using growth charts it is fairly easy for the doctor to show a parent and child where they fall on the growth curve and BMI (body mass index) curve as well. When discussing weight issues it is sometimes difficult to decide what terms are appropriate to use.

A study just published on line in Pediatrics surveyed 445 parents of children 2–18 years of age to assess what are perceived to be the most appropriate terms to be used when discussing weight issues in a child. The study, done at Yale University, was interesting in that more than 60% of parents said that referring to a child as “extremely fat” or “obese” would be “most stigmatizing and the least motivating terms to encourage weight loss.”

In this study, American parents preferred that terms such as “unhealthy weight”, “weight problem” or “being overweight” be used to discuss weight issues and that these terms would also be more motivating for weight loss.

In the same study about 36% of parents said that they would “put their children on a strict diet” in response to weight stigma from a doctor. This is concerning as well as since research has shown that severe dieting and restriction of calories in young children may backfire and may at times lead to other issues including eating disorders.

Whether we call it an unhealthy weight or being overweight or even using the term fat probably depends on each family and their own preferences. But whatever we call it, the topic should be addressed at each well child visit. The basic tenets of a healthy body weight still depend on eating a well balanced diet and getting daily exercise. Why does that sound so simple?

The easiest way to start to control weight gain is to begin with good habits when your children are young. If children are raised from their toddler years with a wide variety of healthy foods presented to them at meal and snack time, they will learn to enjoy these foods. “Grazing” should be discouraged and discussions should not be about “what you will or won’t eat” but rather about gathering for family meals and enjoying the time together. Parents needn’t be “short order” cooks, a child will eat if they are hungry and given the opportunity. But by offering a limited variety of foods and preparing just a few items that a child “likes” the stage is already being set for poor eating habits down the road.

Our job as parents is to provide healthy meals (and snacks) to our children, while the children will have to decide whether or not to eat it. There will be days that they are getting their favorite foods and others that they may not, but in the long run they will be a better and healthier eater. It would be nice not to have to figure out the correct term to use for being overweight or even obese.  Maybe we can cure it in the next generation and the terminology will become obsolete!

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

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