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Your Teen

Teen’s E-cigarette Use Linked to Family and Friends

2:00

For many teens, e-cigarettes have taken the place of the traditional combustible cigarette. A new study suggests that teenagers are more likely to use electronic cigarettes if their friends or a family member uses them.

It’s a pretty safe bet that no teen ever started smoking traditional cigarettes because they tasted good. More than likely it was because someone thought it was cool, felt like walking on the edge of rebellion, watched family members light up on a daily basis or a friend pressured them to give it a try.

These days, the reasons teens smoke e-cigarettes are pretty much the same as they are for regular cigarettes. However, these new nicotine packed products have a number of appealing differences for those just starting out. They don’t smell bad or leave a lingering aroma, they taste a little like candy, and no one is quite sure whether they are producing unhealthy side effects that will come back to haunt you later in life.

“There is a lot of concern by the public health community that e-cigarettes may be recruiting a whole new group of people who never smoked cigarettes," said lead author Jessica Barrington-Trimis of the University of Southern California in Los Angeles.

Other studies have linked e-cigarette and traditional cigarette use, but this new study suggests that teens who begin smoking with e-cigarettes may belong to their own unique group.  

Researchers found that many of the teens in the study that said they'd recently used e-cigarettes, had never smoked traditional cigarettes. This was their first venture into smoking.

"If you think of e-cigarette and cigarette use as two circles, the overlap isn’t as big as expected," Barrington-Trimis said.

Using data collected in 2014 from 2,084 Southern California teens, the authors found that about 25 percent reported ever using e-cigarettes and about 20 percent reported ever using traditional cigarettes.

This finding is a cause for concern because e-cigarettes were the dominant tobacco product used, and a substantial proportion of e-cigarette users had no history of cigarette use, the authors noted in their report.

Fourteen percent of teens thought e-cigarettes are not harmful, compared to about 1 percent who thought cigarettes are not harmful. The teens also felt their peers were more likely to accept their e-cigarette use than traditional cigarette use.

Like many other studies on the use of e-cigarettes, this one can’t say with absolute certainty that smoking e-cigarettes leads to smoking traditional cigarettes. However, the researchers suggest that the more accepted these products become by teenagers, the more they contribute to the “re-normalization” of tobacco products.

"Our findings really suggest there’s a lot of kids who are using these e-cigarettes," Barrington-Trimis said.

The lack of research makes it difficult to know what to tell people about e-cigarettes, she added.

She said parents should tell their children that while research into the health effects of e-cigarettes is still in its infancy, nicotine is known to impact youngsters' developing brains.

Nicotine is also highly addictive and one of the most difficult drugs to break free from.  The longer you smoke – whether it’s e-cigarettes or combustible cigarettes – the harder it is to quit. Plus, little is known about the chemicals used to create the sweet tasting flavors of e-cigarettes.

Parents should make sure they know if their child or their child’s friends are using e-cigarettes. Unfortunately in this day and age, discussions about smoking and drug use have to begin early in a child’s life. Waiting till your child is a pre-teen or teenager to talk about e-cigarettes may be too little too late.  

Source: Andrew M. Seaman, http://www.reuters.com/article/2015/07/27/us-health-teens-smoking-ecigarettes-idUSKCN0Q11YC20150727

http://pediatrics.aappublications.org/content/early/2015/07/21/peds.2015-0639.full.pdf+html

Your Child

Adult and Childhood ADHD Two Different Disorders?

1:45

A couple of recent studies are taking a new look at the differences in adult and childhood ADHD.

They suggest that adult ADHD is not just a continuation of childhood ADHD, but that the two are different disorders entirely.

In addition, the researchers say that adult-onset ADHD might actually be more common than childhood onset.

The two studies used similar methodology and showed fairly similar results.

The first study, conducted by a team at the Federal University of Rio Grande do Sul in Brazil, evaluated more than 5,000 individuals born in the city of Pelotas in 1993. Approximately 9 percent of them were diagnosed with childhood ADHD — a fairly average rate. Twelve percent of the subjects met criteria for ADHD in adulthood — significantly higher than the researchers expected — but there was very little overlap between the groups. In fact, only 12.6 percent of the adults with ADHD had shown diagnosable signs of the disorder in childhood.

The second study, which looked at 2,040 twins born in England and Wales from 1994-5, found that of 166 subjects who met the criteria for adult ADHD, more than half (67.5 percent) showed no symptoms of ADHD in childhood. Of the 247 individuals who had met the criteria for ADHD in childhood, less than 22 percent retained that diagnosis into adulthood.

These reports support findings from a third study from New Zealand, published in 2015. Researchers followed subjects from birth to age 38. Of the patients who showed signs of ADHD in adulthood in that study, 90 percent had demonstrated no signs of the disorder in childhood.

While the results from these studies suggests that the widely accepted definition of ADHD – a disorder that develops in childhood, is occasionally “outgrown” as the patient ages- may need to be reassessed.

However, not everyone is on board with the recent findings. Some experts suggest that the study’s authors may have simply missed symptoms of ADHD in childhood in cases where it didn’t seem to become apparent until adulthood.

“Because these concerns suggest that the UK, Brazil, and New Zealand studies may have underestimated the persistence of ADHD and overestimated the prevalence of adult-onset ADHD, it would be a mistake for practitioners to assume that most adults referred to them with ADHD symptoms will not have a history of ADHD in youth,” write Stephen Faraone, Ph.D., and Joseph Biederman, M.D., in an editorial cautioning the ADHD community to interpret the two most recent studies with a grain of salt. They called the findings “premature.”

In both of these studies and in previous research, adult ADHD has been linked to high levels of criminal behavior, substance abuse, traffic accidents and suicide attempts. These troubling correlations remained even after the authors adjusted for the existence of other psychiatric disorders — proving once again that whether it develops in childhood or adulthood, untreated ADHD is serious business.

Both of the studies challenge conventional beliefs that childhood onset ADHD is more likely to continue into adulthood. Many experts would like to see more research on this topic to verify these findings

The two studies were published in the July 2016 issue of JAMA Psychiatry.

Story source: Devon Frye, http://www.additudemag.com/adhdblogs/19/12040.html

Your Baby

Kids of Obese Mothers at Higher Risk for Autism, ADHD

1:45

A new study points out another reason that obesity and pregnancy can be a bad combination not only for the mother but for her future child as well.

Researchers found that six-year-olds whose mothers were severely obese before pregnancy are more likely to have developmental or emotional problems than kids of healthy-weight mothers.

The lead author of the study, Heejoo Jo of the Centers for Disease Control and Prevention (CDC), and her team reviewed data on 1,311 mother-child pairs collected between 2005 and 2012, including the mothers’ body mass index (BMI, a height-to-weight ratio) before pregnancy and their reports of the children’s psychosocial difficulties at age six.

The researchers also incorporated the children’s developmental diagnoses and receipt of special needs services.

Kids of moms who were severely obese, with a BMI greater than 35, were twice as likely to have emotional symptoms, problems with peers and total psychosocial difficulties compared to kids of moms who had a healthy BMI, between 18.5 and 25.

Their children were three times as likely to have a diagnosis of autism spectrum disorder and more than four time as likely to have attention-deficit/hyperactivity disorder (ADHD), as reported in the journal Pediatrics.

Previous studies have shown a connection with autism and maternal diabetes and obesity.

Researchers took into account pregnancy weight gain, gestational diabetes, breastfeeding duration, postpartum depression and infant birth weight. None of these explained the apparent association.

“We already do know that obesity is related to health problems during pregnancy and throughout the lifetime,” Jo said. “I think this adds to that by suggesting that not only does severe obesity affect a woman’s health but the health of her future children.”

This study could not analyze the mechanism linking severe obesity and later risk for developmental problems, Jo noted.

“One theory that we could not look at and needs further research was some small studies have linked maternal obesity to increased inflammation, which might affect fetal brain development,” she told Reuters Health by phone.

While it sounds cliché because we’ve heard it so much; obesity in America has reached epidemic status. Almost 30 percent of Americans are obese and the prevalence of maternal obesity has risen rapidly in the last two decades.

In the USA, approximately 64% of women of reproductive age are overweight and 35% obese.

Women’s health specialists recommend that obese women considering pregnancy lose weight before they conceive to help reduce health risks for themselves as well as their child.

The Academy of Pediatrics recommends that all children be screened for developmental delay or disability at nine, 18 and 24 or 30 months of age.

Health experts strongly suggest that women who were obese or severely obese when they became pregnant make sure that their children receive these developmental screenings.

Sources: Kathryn Doyle, http://www.reuters.com/article/2015/04/28/us-obese-pregnancy-adhd-kids-idUSKBN0NJ2FC20150428

James R. O'Reilly, Rebecca M. Reynolds, http://www.medscape.com/viewarticle/776504

Your Child

Tonsillectomy: Risky for Some Kids With Sleep Apnea

2:00

A tonsillectomy is the primary treatment suggested for children with sleep apnea. For a majority of children, it works well to alleviate their sleeping problems. However, for some children that have a tonsillectomy to treat sleep apnea, they are more likely to suffer breathing complications afterwards according to a new study.

Researchers found that across 23 studies, about 9 percent of children undergoing a tonsillectomy developed breathing problems during or soon after the procedure. But the risk was nearly five times higher for kids with sleep apnea, versus other children.

While some children may be at a higher risk for breathing difficulties, the researchers said that parents shouldn’t be scared of the procedure for their child, but should be extra vigilant about watching their little one for symptoms of respiratory distress, particularly during the first 24 hours after the procedure.

"After they go home, parents should be attentive for breathing problems. That includes checking on your child while he or she is sleeping, at least for the first 24 hours," said Dr. David Gozal, chief of pediatrics at the University of Chicago.

"In most instances, nothing will happen," Gozal said. "But it's important for parents to be aware that tonsillectomy can have [complications], like any other surgical procedure."

The study also noted that physicians should be aware that children with sleep apnea have higher odds of respiratory complications, such as low oxygen levels in the blood, during and shortly after the procedure.

Anywhere from 1 percent to 5 percent of children have obstructive sleep apnea, a disorder in which tissues in the throat constrict during sleep, causing repeated pauses in breathing. Loud snoring is the most obvious symptom, but daytime sleepiness and attention problems are also red flags.

In children, sleep apnea often stems from chronic inflammation in the tonsils and adenoids, infection-fighting tissues in the back of the throat and nasal cavity. So surgery to remove the tissue is often recommended.

In the United States, about half a million children have a tonsillectomy each year, and sleep apnea is the most common reason why, Gozal said.

Because sleep apnea keeps children from sleeping well, they can become irritable and develop attention and behavior problems in school.

The procedure is often effective: Studies show that around 80 percent of kids see their symptoms go away or substantially improve.

The findings are based on 23 studies that looked at tonsillectomy complications. Overall, Gozal's team found, the most common issues included "respiratory compromise," bleeding, pain and nausea.

Four of the studies differentiated kids having surgery for sleep apnea from those having it for recurrent tonsil infections. Across those studies, children with sleep apnea were five times more likely to have respiratory complications.

On the other hand, they were at lower risk of bleeding -- for reasons that are unclear, Gozal said.

Gozal had another piece of advice for parents: "If tonsillectomy is being recommended to treat sleep apnea, make sure your child really has sleep apnea."

Loud snoring and daytime grogginess are symptoms, but the only definitive way to diagnose sleep apnea is through an overnight stay in a sleep lab, Gozal said.

Source: Amy Norton, http://www.webmd.com/children/news/20150921/tonsillectomy-for-sleep-apnea-carries-risks-for-some-kids-study

 

 

Your Teen

Shampoos & Cosmetics Loaded With Chemicals May Be Harming Teen Girls

2:00

The trend in chemical-free cosmetics and shampoos may be a healthier choice for everyone, particularly teen-age girls. A new study found that common hormone-disrupting chemicals found in many shampoos and cosmetics, may have a negative impact on the reproductive development of adolescent girls. 

Chemicals widely used in personal care products -- including phthalates, parabens, triclosan and oxybenzone -- have been shown to interfere with the hormone system in animals, the researchers explained. These chemicals are found in many fragrances, cosmetics, hair products, soaps and sunscreens.

"Because women are the primary consumers of many personal care products, they may be disproportionately exposed to these chemicals," said study lead author Kim Harley. She is associate director of the Center for Environmental Research and Children's Health at the University of California, Berkeley.

"Teen girls may be at particular risk since it's a time of rapid reproductive development, and research has suggested that they use more personal care products per day than the average adult woman," Harley added in a university news release.

Researchers noted that cosmetic and personal care products are not well regulated in the United States, so it’s difficult to get good data on their health effects.

However, there is increasing evidence linking hormone-disrupting chemicals with behavioral problems, obesity and cancer cell growth, the researchers said.

"We know enough to be concerned about teen girls' exposure to these chemicals. Sometimes it's worth taking a precautionary approach, especially if there are easy changes people can make in the products they buy," Harley said.

The study involved 100 Hispanic teens that used make-up, shampoo and lotion products labeled chemical-free. The girl’s urine was analyzed before and after the three - day trial. The participants showed a significant drop in levels of the hormone-disrupting chemicals in their bodies.

Metabolites of diethyl phthalate, commonly used in fragrances, decreased 27 percent by the end of the trial period. Methyl and propyl parabens, used as preservatives in cosmetics, dropped 44 and 45 percent respectively.

Benzophenone-3 (BP-3), found in some sunscreens under the name oxybenzone, fell 36 percent.

Kimberly Parra, study co-director, said it was important to involve local youth in the design and implementation of the study.

“The results of the study are particularly interesting on a scientific level, but the fact that high school students led the study set a new path to engaging youth to learn about science and how it can be used to improve the health of their communities,” she said. “After learning of the results, the youth took it upon themselves to educate friends and community members, and presented their cause to legislatures in Sacramento.”

Many of the chemical-free products cost more than regular shampoos and cosmetics, tempting college students and younger teen families to choose the less expensive brands.

However, splurging more on products with fewer chemicals may pay off in the future, researchers said.

The study was published in the journal Environmental Health Perspectives.

Story Sources: Robert Preidt, http://consumer.healthday.com/environmental-health-information-12/chemical-health-news-730/teens-cosmetics-chemicals-708646.html

Sarah Yang, http://universityofcalifornia.edu/news/teen-girls-see-big-drop-chemical-exposure-switch-cosmetics

 

 

 

Your Child

Preschoolers Should be Examined for Possible Vision Problems

2:00

For very young children, blurry vision may seem normal to them. There’s also a good chance that their parents won’t know their little ones are having difficulty seeing clearly.

That’s why the U.S. Preventive Services Task Force (USPSTF) is recommending that 3 to 5 year olds receive vision screening at least once to detect abnormal visual development or risk factors for it.

A couple of visions problems that first show symptoms at this age are Strabismuc (crossed eyes) and Amblyopia (lazy eye).)

Crossed eyes do not look in the same direction at the same time. Six muscles attach to each eye to control how it moves. The muscles receive signals from the brain that direct their movements. Normally, the eyes work together so they both point at the same place. When problems develop with eye movement control, an eye may turn in, out, up or down.

Infants and young children often develop this condition by the age of three, but older children and adults can also get crossed eyes. People often believe that a child with strabismus will outgrow the condition. However, this is not true. In fact, strabismus may get worse without treatment. An optometrist should examine any child older than 4 months whose eyes do not appear to be straight all the time.

Lazy eye is the loss or lack of development of central vision in one eye that is unrelated to any eye health problem and is not correctable with lenses.

Lazy eye often occurs in people who have crossed eyes (misalignment) or a large difference in the degree of nearsightedness or farsightedness between the two eyes. It usually develops before age 6 and it does not affect side (peripheral) vision.

Treatment for lazy eye may include a combination of prescription lenses, prisms, vision therapy and eye patching. In vision therapy, patients learn how to use the two eyes together, which helps prevent lazy eye from reoccurring.

According to the American Public Health Association, about 10% of preschoolers have eye or vision problems. However, children this age generally will not voice complaints about their eyes.

Parents should watch for signs that may indicate a vision problem, including:

•       Sitting close to the TV or holding a book too close

•       Squinting

•       Tilting their head

•       Frequently rubbing their eyes

•       Short attention span for the child's age

•       Turning of an eye in or out 

•       Sensitivity to light

•       Difficulty with eye-hand-body coordination when playing ball or bike riding

•       Avoiding coloring activities, puzzles and other detailed activities

If you notice any of these signs in your preschooler, arrange for a visit to your doctor of optometry.

While the two may sound similar, there is a difference between a vision screening and an eye exam.

Vision screenings are a limited process and can't be used to diagnose an eye or vision problem, but rather may indicate a potential need for further evaluation. They may miss as many as 60% of children with vision problems. Even if a vision screening does not identify a possible vision problem, a child may still have one.

Sometimes, parents get a false sense that their child doesn’t have a vision problem if he or she passes a vision screening.

A doctor of optometry performs an eye exam. He or she will look for any developmental problems and evidence of disease. If needed, your doctor of optometry can prescribe treatment, including eyeglasses and/or vision therapy, to correct a vision development problem.

When considering an eye exam, parents should:

•       Make an appointment early in the day. Allow about one hour.

•       Talk about the examination in advance and encourage your child's questions.

•       Explain the examination in terms your child can understand, comparing the E chart to a puzzle and the instruments to tiny flashlights and a kaleidoscope.

The preschool years are a time for developing the visual abilities that a child will need in school and throughout his or her life. Steps taken during these years to help ensure vision is developing normally can provide a child with a good "head start" for school.

Story sources:

http://www.aoa.org/patients-and-public/good-vision-throughout-life/childrens-vision/preschool-vision-2-to-5-years-of-age?sso=y

Molly Walker, http://www.medpagetoday.com/ophthalmology/generalophthalmology/63476

 

Daily Dose

Should Children Lift Weights?

I am often asked by both young patients and their parents if children can participate in weight lifting and strengthening exercises.

I think the appropriate term is strength training and conditioning, rather than weight lifting, which connotes competition and the need for heavier and heavier weights. When done appropriately, strength training and conditioning is great for kids of all ages, and really encourages being physically fit. Weightlifting is not appropriate for a growing child as it can put too much strain on the tendons and cartilage. This is especially true when kids become competitive about lifting bigger and bigger weights at the risk of long-term injury. Allowing children to weight lift in hopes of “bulking up” or “building the biggest muscles” before pubertal development and their growth spurt is inappropriate. All of that can be deferred for the post pubertal athlete. On the other hand, an age appropriate strength training and conditioning program may actually be protective of a child’s joints by increasing their muscle strength and their endurance. By participating in supervised and structured strengthening programs, a child as young as eight may improve their endurance, body awareness and balance, all of which are beneficial. A strength-training program can be done without weights, as in resistance training, by simply using the child’s body weight. Examples of this would be abdominal crunches, push-ups and pull-ups. These are great ideas for the younger children. For older children free weights or resistance bands may be added. Parents or coaches who are familiar with the use of free weights should always supervise. Start out with lighter weights, and make sure that the child can do at least 10 repetitions with the weight, if not, drop to a lower free weight. Have the adult watch the child for form and technique and supervise any increase in weights or repetitions. There are also many programs through local gyms and YMCA’s tailored just for kids to participate in strength training. When beginning a conditioning program encourage your child to have a warm up period, with a little aerobic activity like walking or running as this his will help to warm the muscles and prevent injury. After the strength training it is equally important to have a cool down period with gentle stretching. Many children enjoy working out with their parents and this can become a family activity (we can all use the exercise) to promote coordination, healthy bones, joints, cholesterol and blood pressure. Most importantly make it fun! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

HPV Vaccine

1:30 to read

I don’t think I have posted the latest good news about vaccines. As you know I am a huge proponent of vaccinating children (and ourselves), and remind patients that there continue to be ongoing studies regarding vaccine safety, as well as efficacy.  The CDC and ACIP recently announced that the HPV vaccine may be protective and effective after just 2 doses of vaccine rather than the previous recommendation of a series of 3 vaccines.  That is good news for teens, especially those that are “needle phobic”!  

 

The ACIP (Advisory Committee on Immunization Practices  recommended  a 2 dose HPV vaccine series for young adolescents, those that begin the vaccine series between 11 and 14 years.  For adolescents who begin the HPV vaccine series at the age 15 or older, the 3 dose series is still recommended.

 

This recommendation was based upon data presented to the ACIP and CDC from clinical trials which showed that two doses of HPV vaccine in younger adolescents (11-14 years old) produced an immune response similar or higher than the response in older adolescents (15 yrs or older). 

 

The HPV vaccine, which prevents many different types of cancer caused by human papilloma virus, has been routinely recommended beginning at age 11 years  approved to use as young as 9 years), but unfortunately only about 42% of girls and 28% of teenage boys has completed the 3 dose series.  

 

By showing that a 2 dose series (when started at younger ages) is effective and protective the hope is that more and more young adolescents will complete the series.  The two doses now must be spaced at least 6 months apart and may even be given at the 11 year and then 12 year check up which would not require as many visit to the pediatrician.

 

According to the CDC more HPV - related cancers have been diagnosed in recent years, and reported more than 31,000 new cases of cancer each year (from 2008 - 2012) were attributable to HPV, and that routine vaccination could potentially prevent about 29,000 cases of those cancers from occurring.  But, in order to see these numbers shrink, more and more adolescents need to be immunized…before they are ever exposed to the virus. Remember, the HPV vaccine is protective against certain strains of HPV, but does not treat HPV disease.

 

So..once again a good example of using science based evidence to provide the best protection against a serious disease…with less shots too!! Win - Win!!

 

 

Your Child

Getting Ready for a New School Year!

2:00

As summer break begins to wind down, preparations for a new school year are gearing up.  Whether it’s the first day of school for your little one or your teen’s first year of college, making the transition from vacation to a daily schedule requires some pre-planning.

Typically, the most difficult changeover for everyone is getting used to a regulated bedtime routine. Getting enough sleep will help family members handle the switch better. I know that’s much easier said than done, but it's worth the effort. Now is a good time to start preparing for a new school year schedule.

As pediatrician, Dr. Sue Hubbard, has said previously in her kidsdr.com Daily Dose article, a couple of weeks before the start of a new school year is when families should start getting used to a new schedule.

“In order to try and minimize grouchy and tired children (and parents too) during those first days of school, going to bed on time will be a necessity. Working on re-adjusting betimes now will also make the transition from summer schedule to school schedule a little easier. If your children have been staying up later than usual, try pushing the bedtime back by 15 minutes each night and gradually shifting the bedtime to the “normal” hour. At the same time, especially for older children, you will need to awaken them a little earlier each day to re-set their clocks for early morning awakening,” Hubbard noted.

Another important detail to take care of before school begins is making sure your child is current on all immunizations. Each state has its own requirements and exemptions. In Texas for instance:

K-12 grades are required to have - the Tetanus/ Diphtheria/ Pertussis (Tdap) vaccine, Measles, Mumps and Rubella (MMR) vaccine, the Polio vaccine, Hepatitis B vaccine, and the varicella vaccine. K through 6th grade are also required to get the Hepatitis A vaccine and 7th through 12 grades, a meningococcal vaccine.

Also highly recommended, but not a state law requirement, is the Human Papillomavirus Vaccination (HPV) for boys and girls.

You can find out exactly what your state’s school immunization program is by logging onto http://www.cdc.gov/vaccines/imz-managers/awardee-imz-websites.html and clicking on your state.

And lets not forget our college bound students! Universities have their own policies, but these vaccines and booster shots are highly recommended by physicians and most universities: Meningococcal conjugate vaccine (MenACWY), Tdap, HPV vaccine and the seasonal flu vaccine. Be sure to check with your child’s school to see what specific vaccines are required or suggested.

The first day of school for kindergarteners and / or first-graders can be unsettling for kids and parents. Here are a few ways you can help your child face the uncertainty:

·      Remind your child that there are probably a lot of students who are uneasy about the first day of school. This may be at any age. Teachers know that students are nervous and will make an extra effort to make sure everyone feels as comfortable as possible.

·      Point out the positive aspects of starting school.  She'll see old friends and meet new ones. Refresh her positive memories about previous years, when she may have returned home after the first day with high spirits because she had a good time.

·      Find another child in the neighborhood with whom your student can walk to school or ride on the bus.

·      If it is a new school for your child, attend any available orientations and take an opportunity to tour the school with your child before the first day.

·      If you feel it is needed, drive your child (or walk with him or her) to school and pick them up on the first day.

Nutrition is an important factor in children doing well in school. During the summer break kids often get off schedule with their eating habits. Start the early morning routine at least a week before school actually starts so that everyone has a chance to get used to having and preparing breakfast early.

Studies have shown that children who eat healthy, balanced breakfasts and lunches are more alert throughout the school day and earn higher grades than those who have an unhealthy diet. 

Back-to-school- shopping, new schedule arrangements, homework time and space, immunizations, after-school sports and activities – they’re all part of a new school year.

One way to help keep everybody on track is with a calendar that is placed where everyone can see it and update it.

Here’s to a new school year that is full of learning, exciting experiences and good grades!

Source: http://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/Pages/Back-to-School-Tips.aspx

 

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DR SUE'S DAILY DOSE

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