Twitter Facebook RSS Feed Print
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

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 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

Your Child

New Guidelines for How Much Sleep Kids Really Need

2:00

As adults, we all know that without a good night’s sleep, we’re going to be struggling to get through the day’s activities. When we’re not running on all rested cylinders, small troubles seem like mountains, being able to focus and complete a project is difficult and nodding off while driving is more likely to happen.

Restful sleep is a wonderful thing and unfortunately, many of us just aren’t getting enough.

Most adults know about how much sleep they need the night before to feel their best the next day. Children, on the hand, need a certain amount of sleep depending on their age.

For the first time, a new set of sleep guidelines specially tailored to children, have been released from the American Academy of Sleep Medicine. The new recommendations give a precise number of hours for each age range, spanning from infancy up until 18 years old.

"Sleep is essential for a healthy life, and it is important to promote healthy sleep habits in early childhood," said Dr. Shalini Paruthi, fellow of the American Academy of Sleep Medicine, in a statement. "It is especially important as children reach adolescence to continue to ensure that teens are able to get sufficient sleep."

A team of 13 top sleep experts conducted a 10-month research project to find out how much sleep children actually need. The team reviewed 864 published scientific articles that revealed the link between sleep duration and the health of children across all age categories.

Here’s what they found:

·      Infants between 4-12 months of age should get 12 to 16 hours of sleep for any 24-hour period. This includes naps.

·      Children between 1 and 2 years of age need 11 to 13 hours for every 24-hour period.

·      Children between 3 and 5 years old need a little less at 10 to 13 hours per 24-hour period.

·      Children between 6 and 12 years old need 9 to 12 hours of sleep – not including naps- in a 24-hour period.

·      Teens between 13 and 18 years old need 8 to 10 hours per 24-hour period.

All told, babies, kids, and teens spend roughly 40 percent of their childhood asleep, according to the National Sleep Foundation.

The panel points out that the right amount of shut-eye is critical for a child’s developing brain and body and overall mental and physical health.

Researchers also noted that when children do not get enough sleep, their behavior is affected and their long-term health can be negatively impacted.

"Adequate sleep duration for age on a regular basis leads to improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health," the American Academy of Pediatrics (AAP) wrote. "Not getting enough sleep each night is associated with an increase in injuries, hypertension, obesity and depression, especially for teens who may experience increased risk of self-harm or suicidal thoughts."

According to Dr. Nathaniel Watson, the president of the American Academy of Sleep Medicine, making sure that their child gets enough sleep is one of the best ways parents can lay a foundation of healthy habits that children can take with them into adulthood. With more than one third of the adult population sleep deprived, sleep becomes paramount for children to avoid the slew of consequences that come with a lifetime of sleep problems.

"The AAP endorses the guidelines and encourages pediatricians to discuss these recommendations and healthy sleep habits with parents and teens during clinical visits," they announced. "For infants and young children, establishing a bedtime routine is important to ensuring children get adequate sleep each night.”

Story source: Samantha Olson, http://www.medicaldaily.com/how-much-sleep-do-kids-need-sleeping-baby-constantly-tired-389448

Your Teen

Headlines: Another Teen Suicide

On September 6, 2007, the Centers for Disease and Prevention reported suicide rates in American adolescents (especially girls, 10 to 24 years old) increased 8%, the largest increase in 15 years.The sad and desperate story of a college student who killed himself after a roommate secretly videotaped him having sex, and streamed it live on the web has made headlines across the world.

18 year old, Tyler Clementi, was embarrassed and humiliated by the invasion of his privacy. He jumped to his death from the George Washington Bridge. Unfortunately, Tyler is not the only teen who thinks suicide is the only way to end his suffering. On September 6, 2007, the Centers for Disease and Prevention reported suicide rates in American adolescents (especially girls, 10 to 24 years old) increased 8%, the largest increase in 15 years. Amazingly, suicide is the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds. The current headlines demonstrate that it is more important than ever that parents are aware of the symptoms of depression and substance abuse.  Suicides increase substantially when the two are combined. What symptoms should I look for? - Change in eating and sleeping habits - Withdrawal from friends, family, and regular activities. - Violent, rebellious behavior, or running away - Drug and alcohol use. - Unusual neglect of personal appearance - Marked personality change - Persistent boredom, difficulty concentrating, or a decline in the quality of     schoolwork - Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc. - Loss of interest in pleasurable activities. - Not tolerating praise or rewards. A teenager who is planning to commit suicide may also: - Complain of being a bad person or feeling rotten inside. - Give verbal hints with statements such as: “I won't be a problem for you much longer,”    “ Nothing matters,” “It's no use, and I won't see you again.” - Put his or her affairs in order, for example, give away favorite possessions, clean his or her room, throw away important belongings, etc. - Become suddenly cheerful after a period of depression - Have signs of psychosis (hallucinations or bizarre thoughts.) What should you do if you notice these symptoms in your child? If a child or adolescent says, "I want to kill myself," or "I'm going to commit suicide,"  always take the statement seriously and immediately seek assistance from a qualified mental health professional. People often feel uncomfortable talking about death. However, asking the child or adolescent whether he or she is depressed or thinking about suicide can be helpful. Rather than putting thoughts in the child's head, such a question will provide assurance that somebody cares and will give the young person the chance to talk about problems. If one or more of these signs occurs, parents need to talk to their child about their concerns and seek professional help from a physician or a qualified mental health professional. With support from family and appropriate treatment, children and teenagers who are suicidal can heal and return to a healthier mental outlook.

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

Treatment Strategies for Bedwetting

1.15 to read

I receive quite a few emails daily and many have to do with bedwetting. The best way to attack the problem of bedwetting begins when you and your child have had a discussion about their feelings related to bedwetting. This often happens as they get older and continue to have problems with bedwetting and they are anxious or embarrassed. If you bring up the subject and they would rather just wear a pull up at night, and go back to playing outside rather than discuss strategies for staying dry, it is not time to tackle the issue. Timing is everything! As you start to discuss strategies to stop bedwetting, begin with having your child keep a calendar of their dry nights. This gets them involved and gives you an idea of their level of commitment. Then start setting their alarm clock to awake them in the morning and see if they can get up on their own. If the alarm doesn’t wake them up for school it is probably not going to awaken them in the middle of the night. Remind them to recognize their need to go to the bathroom during the day too, and have them go every several hours to feel the sensation of their bladder filling throughout the day. Many of these kids are infrequent voiders during the day and have actually stretched their bladder wall and hypertrophied the bladder muscle. Lastly, make sure that they are not constipated and put them on something like Miralax to ensure that they do not have stool that also compresses the bladder (the colon sits right above the bladder and can push on the bladder). Talk about a reward system that they would like to use while working on the problem. It doesn’t have to be a major reward, small things work equally well. I think the rewards should be given by the week, rather than the day. I also give rewards for effort, not just for dry nights. Trying is the whole idea. Sometimes the brain and bladder are just not ready and you do not want your child to feel defeated even though they have tried their hardest. If all of this is successful it is then time to set up a “bedwetting alarm system” (numerous ones available over the internet). The alarms consist of a bell and pad. The alarm sounds when the pad senses moisture. The alarms that actually buzz are more effective than those that only vibrate. Remember, your child is already hard to arouse and vibration alone will probably not work. Once you begin using the alarm and you hear the alarm go off, you will need to go into their rooms and call their name or shake them too, to actually get them awake and to the bathroom. In the beginning it may almost be like sleep walking them to the bathroom. Then rinse off the pad and reset the alarm and put them back to bed. Over time they should arouse more easily and the time spent awake and going to the bathroom should shorten. As you can see this is disruptive to everyone’s sleep so best done over the summer or a long winter break. It often takes at least a month for bedwetting to stop and the alarm system should really be used for several more months to reinforce the process. There is also a drug call DDAVP that works on the kidneys to reduce the flow of urine. This medication works when given but does not “cure” the problem. I often use this for children who are worried about a camp or overnight experience, before they have started the alarm system regimen. It has not been shown to be as effective as the alarm system, but in difficult cases I have used it in conjunction with the alarm system. You might want to discuss the pros and cons of this drug with your pediatrician. Remember this takes time, motivation and determination on both the parent and child’s part. Remain positive and optimistic throughout the training process. It is not a sprint but a longer race, and don’t expect overnight success. Remind them of their other childhood accomplishments and that with time and determination they will be successful with bedwetting too. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue!

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.

 
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. 

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

Can q-tips harm your baby's ear?

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.