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Your Child

Pre-teen Cholesterol Check-Up

1.45 to read

Do you know your child’s cholesterol level? Unless you have a family history of high cholesterol, getting your child’s checked probably hasn’t been high on your list of medical exams.

A panel of experts appointed by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics, are recommending that children be tested for high cholesterol by age eleven. They also recommend that children who are overweight, be screened every 2 years for diabetes.

Major medical groups already suggest children, with a family history of high cholesterol or diabetes, be screened early. Children without a family history of heart disease or diabetes have traditionally not been screened until their later years. Times have changed though and because of the childhood obesity epidemic many kids are developing heart disease and Type 2 diabetes at a much younger age.

Fats build up in the heart arteries in the first and second decade of life but usually don't start hardening the arteries until people are in their 20s and 30s, said one of the guideline panel members, Dr. Elaine Urbina, director of preventive cardiology at Cincinnati Children's Hospital Medical Center.

"If we screen at age 20, it may be already too late," she said. "To me it's not controversial at all. We should have been doing this for years."

An alarming statistic shows how destructive childhood obesity has become. Autopsy studies show that children already have signs of heart disease, long before they show symptoms. By the fourth grade, 10 percent to 13 percent of U.S. children have high cholesterol, defined as a score of 200 or more.

According to the National Cholesterol Education Program's Expert Panel on Blood Cholesterol in Children and Adolescents, the acceptable level for total cholesterol in kids 2 to 19 years old is less than 170 mg/dL. Their LDL cholesterol should be less than 110 mg/dL, HDL levels should be 35 mg/dL or greater, but preferably over 60, and triglycerides should be 150 mg/dL or less.

Doctors recommend screening between ages 9 and 11 because cholesterol dips during puberty and rises later. They also advise testing again later, between ages 17 and 21.

The rise in Type 2 diabetes, in children, has also increased in the last decade. It is hard to detect type 2 diabetes in children, because it can go undiagnosed for a long time; children may have no symptoms or mild symptoms; and because blood tests are needed for diagnosis. That’s why early screening is so important.

The guidelines also say doctors should:

  • Take yearly blood pressure measurements for children starting at age 3.
  • Start routine anti-smoking advice when kids are ages 5 to 9, and counsel parents of infants not to smoke in the home.
  • Review infants' family history of obesity and start tracking body mass index, or BMI, a measure of obesity, at age 2.

There has been some controversy over doctors using terms like overweight and obese when talking with parents and children about their weight. The panel suggests that these are medically correct terms and should be used so that parents and children understand the importance of the problem.

Children whose BMI is in the 85th to 95th percentile should be called overweight, not "at risk for overweight," and kids whose BMI is in the 95th percentile or higher should be called obese, not "overweight; even kids as young as age 2, the panel said.

"Some might feel that 'obese' is an unacceptable term for children and parents," so doctors should "use descriptive terminology that is appropriate for each child and family," the guidelines recommend.

They were released online by the journal Pediatrics.

Daily Dose

College Students and Curfews

1:30 to read

Colleges are out and many students are home for the summer.  But with the return of your child to “the nest” comes a whole new set of issues. Trust me I have been there (more than once).

Your son or daughter has been living in a dorm, apartment, or house....with their own “rules and routines”.  Most college students living away from home have not had to really answer to anyone. If they want to stay up all night, come home at sunrise or sleep all day....you have not been involved. 

But now they are back....hopefully having managed to do well, despite their crazy schedules.  Does this “new normal” of theirs work at your house? It certainly didn’t in ours, especially where both parents were working.

A friend had advised me, “don’t give them a curfew over the summer , they have not had one at college”.  That may be some of the worse advice I have ever gotten!!  When your child is living in your house and you wake up at 2 am and they are not home....well, you assume the worst, right?  Then you try to call them and it goes to voice mail...of course...more worry. After one night like that pacing the floors I knew in my heart of hearts that summer rules, even for college kids are a must!

So, at our house college students (I don’t care how old), need to be respectful of house rules.  Even if they can get up and go to work after 3 hours of sleep, I can’t.  So midnight curfew, just like high school, goes back into place. Nothing good happens after midnight anyway, right?  If they want to stay up in their room or go watch TV in the den, or make a sandwich at 2 am, that is fine by me. I just want to know that they are home and I don’t have to dream about horrible events that are happening when I don’t know where they are.  They always ask, “you don’t know what I am doing when I am at school, so what’s the difference?”  The difference is , “out of sight, out of mind” (sort of).  In my mind I can imagine that they are tucked in their dorm bed at 10 pm.....I always think good thoughts. Those unsettling thoughts only come when they are home.... and that bed is empty.  

Your Teen

10 Reasons Teens Act The Way They Do

2:30

Anyone in the midst of raising a teen knows that the adolescent years can be some of the most difficult to get through and understand.

As a parent or guardian of a teenager that wants to be more independent, but also needs supervision and guidance, the times can be challenging indeed.

If that’s the position you find yourself in, you may be asking – what’s going on in that youngster’s brain? Actually, there’s a lot happening!

There are several scientific reasons an adolescent brain can be similar to a toddler’s: After infancy, the brain's most dramatic growth spurt occurs in adolescence. Here’s 10 things you may not know about your teen’s brain.

10. Critical period of development. Adolescence is generally considered to be the years between 11 and 19. It’s easy to see the outward changes that occur in boys and girls during this time, but inside, their brains are working on overdrive.

"The brain continues to change throughout life, but there are huge leaps in development during adolescence," said Sara Johnson, an assistant professor at the Johns Hopkins Bloomberg School of Public Health.

Parents should understand that no matter how tall their son has sprouted or how grown-up their daughter dresses, "they are still in a developmental period that will affect the rest of their life," Johnson told LiveScience

9. The growing brain. Scientists used to believe the greatest leap in neuronal connections occurred in infancy, but brain imaging studies show that a second burst of neuronal sprouting happens right before puberty, peaking at about age 11 for girls and 12 for boys.

The adolescent's experiences shape this new grey matter, mostly following a "use it or lose it" strategy, Johnson said. The structural reorganization is thought to continue until the age of 25, and smaller changes continue throughout life.

8. New Thinking Skills. This increase in brain matter allows the teenager to become more interconnected and gain processing power, Johnson notes.

If given time and access to information, adolescents start to have the computational and decision-making skills of an adult. However, their decisions may be more emotional than objective because their brains rely more on the limbic system (the emotional seat of the brain) than the more rational prefrontal cortex.

"This duality of adolescent competence can be very confusing for parents," Johnson said, meaning that sometimes teens do things, like punching a wall or driving too fast, when, if asked, they clearly know better.

Sound familiar?

7.  Teen tantrums. While teens are acquiring amazing new skills during this time, they aren’t that good at using them yet, especially when it comes to social behavior and abstract thought.

That’s when parents can become the proverbial guinea pig. Many kids this age view conflict as a type of self-expression and may have trouble focusing on an abstract idea or understanding another's point of view.

Particularly in today’s heavy media influenced world, teens are dealing with a huge amount of social, emotional and cognitive flux says Sheryl Feinstein, author of Inside the Teenage Brain: Parenting a Work in Progress (Rowman and Littlefield, 2009.)

That’s when they need a more stable adult brain (parents) to help them stay calm and find the better path.

6. Intense emotions. Remember the limbic system mentioned earlier (the more emotional part of the brain)? It’s accelerated development, along with hormonal changes, may give rise to newly intense experiences of rage, fear, aggression (including towards oneself), excitement and sexual attraction.

Over the course of adolescence, the limbic system comes under greater control of the prefrontal cortex, the area just behind the forehead, which is associated with planning, impulse control and higher order thought.

As teens grow older, additional areas in the brain start to help it process emotions and gain equilibrium in decision-making and interpreting others. But until that time, teens can often misread parents and teachers Feinstein said.

5. Peer pressure. As teens become better at abstract thinking, their social anxiety begins to increase.  Ever wonder why your teen seems obsessed with what others are thinking and doing?

Abstract reasoning makes it possible to consider yourself from the eyes of another. Teens may use this new skill to ruminate about what others are thinking of them. In particular, peer approval has been shown to be highly rewarding to the teen brain, Johnson said, which may be why teens are more likely to take risks when other teens are around.

Friends also provide teens with opportunities to learn skills such as negotiating, compromise and group planning. "They are practicing adult social skills in a safe setting and they are really not good at it at first," Feinstein said. So even if all they do is sit around with their friends, teens are hard at work acquiring important life skills.

4. Measuring risk.  "The brakes come online somewhat later than the accelerator of the brain," said Johnson, referring to the development of the prefrontal cortex and the limbic system respectively.

At the same time, "teens need higher doses of risk to feel the same amount of rush adults do," Johnson said. Not a very comforting thought for parents.

This is a time when teens are vulnerable to engaging in risky behaviors, such as trying drugs, sex, getting into fights or jumping into unsafe water.

So what can a parent do during this risky time? "Continue to parent your child." Johnson said. Like all children, "teens have specific developmental vulnerabilities and they need parents to limit their behavior," she said.

It’s when being a parent to your child instead of trying to be their “friend” is more difficult but much more important for their physical and emotional safety.

3. Yes, parents are still important. According to Feinstein, a survey of teenagers revealed that 84 percent think highly of their mothers and 89 percent think highly of their fathers. And more than three-quarters of teenagers enjoy spending time with their parents; 79 percent enjoy hanging out with Mom and 76 percent like chilling with Dad. That’s not 100%, but it’s probably more than you thought.

One of the tasks of adolescence is separating from the family and establishing some autonomy, Feinstein said, but that does not mean a teen no longer needs parents – even if they say otherwise.

"They still need some structure and are looking to their parents to provide that structure," she said. "The parent that decides to treat a 16 or 17 year old as an adult is behaving unfairly and setting them up for failure." 

Listening to your teen and being a good role model, especially when dealing with stress and the other difficulties life can present, can help your teen figure out their own coping strategies.

2. Sleep. Ah, yes, sleep. Although teens need 9 to 10 hours of sleep a night, their bodies are telling them a different story. Part of the problem is a shift in circadian rhythms during adolescence: It makes sense to teen bodies to get up later and stay up later, Johnson said.

But due to early bussing and class schedules, many teens rack up sleep debt and "become increasingly cognitively impaired across the week," Johnson said. Sleep-deprivation only exacerbates moodiness and cloudy decision-making. And sleep is thought to aid the critical reorganization of the teen brain.

"There is a disconnect between teen’s bodies and our schedules," Johnson said.

Shutting down the electronics an hour before bedtime has been shown to help teens as well as adults get to sleep quicker and sleep better. No computer, TV, video games or cell phones.

1.The “I am the Center of the Universe” syndrome. You may have noticed that your teen’s hormones are causing quite a bit of havoc. Experts say that’s to be expected. But you may still wonder- what the heck is going on with my kid?

The hormone changes at puberty have huge affects on the brain, one of which is to spur the production of more receptors for oxytocin, according to a 2008 issue of the journal Developmental Review.

The increased sensitivity caused by oxytocin has a powerful impact on the area of the brain controlling one’s emotions. Teens develop a feeling of self-consciousness and may truly believe that everyone is watching him or her. These feelings peek around age 15.

While this may make a teen seem self-centered (and in their defense, they do have a lot going on), the changes in the teen brain may also spur some of the more idealistic efforts tackled by young people throughout history.

"It is the first time they are seeing themselves in the world," Johnson said, meaning their greater autonomy has opened their eyes to what lies beyond their families and schools. They are asking themselves, she continued, for perhaps the first time: What kind of person do I want to be and what type of place do I want the world to be?

Until their brains develop enough to handle shades of grey, their answers to these questions can be quite one-sided, Feinstein said, but the parents' job is to help them explore the questions, rather than give them answers.

And there you have it. Teen’s brains are exploding with new data, confusing signals and dueling desires. It’s a tough time in one’s development- but rest assured, what you teach them by example and compassion as well as how you gingerly help guide them will last a life-time. Even when you do the best you can, there are no guarantees that they will turn out the way you’re hoping they will – they are after all- individuals with a will and a mind of their own. But now you know a little more about why your teen acts the way they do.

Story Source: Robin Nixon, http://www.livescience.com/13850-10-facts-parent-teen-brain.html

Daily Dose

Bug Bites

1:30 to read

It is the time of year for bugs and bites and I see a lot of kids with bites coming into my office.  Parents want to know “what kind of bite it is?” and in most of the kids I see, they are having a reaction to a mosquito bite. Parents are extremely concerned that the reaction may be abnormal and lead to breathing issues or that the bite it is infected. For some reason, baby and toddler skin just seems to swell more - that is not science but my observation…maybe because they are “yummier”?  At any rate, the best way to avoid “the mystery bite” is by using insect repellent.

 

The AAP recommends that children be protected from mosquitoes as they may not only cause discomfort and itching, but may cause several viral illnesses including West Nile, Zika and Chikungunya. Insect repellents will also prevent ticks, some of which may transmit Lyme Disease.  

 

Both the AAP and CDC recommend the use of DEET containing repellents for children 2 months of age and older. For young infants it is often easy to protect them from bites by using mosquito netting over their stroller or carseat when they are outdoors.  Once your child is older and hard to “contain” beneath mosquito netting you may use a DEET containing repellent and start with the lowest concentration - you will need to read the labels on each product.  The protection and effectiveness for DEET products of different concentrations is similar, but a higher concentration provides a longer duration of protection. Picardin has also been approved for use in concentrations of 5-10 %. The higher the concentration the longer the duration of protection as well.  So choose accordingly. I often have several products at our house and decide which to use based on the length of time we are enjoying the backyard, age of child or adult and method which I want to use to apply (spray, lotion, wipes).

 

You do not want to choose a product that contains both sunscreen and an insect repellent. Sunscreen should be applied about every 2 hours and bug spray should be applied far less frequently. I recommend applying the insect repellent with my hands rather than trying to spray a young child who is a moving target. I even put the bug spray on those precious bald baby heads (if over 2 months).  It is also important to wash the insect repellent off at the end of the day - bath time for all!

 

It is also important to dress appropriately if you are going outdoors. When possible dress your child in long sleeves, pants and even socks which will prevent bites. Avoid brightly colored and flowery clothes (may be boring), as these too attract insects.

 

It is also especially important to remove standing water around your house and yard. After a rain or watering check any standing water and empty any residual water from buckets, candles, bird baths or empty pots. Standing water is an easy breeding ground for mosquito larvae.  The type of mosquito that carries Zika also prefers to be close to houses…so it is really important drain standing water near your house. 

 

Enjoy the summer and don’t be afraid of bug sprays in children if you use them appropriately, as prevention is always preferable!

 

 

Your Teen

Are Today’s Teens Avoiding Adulthood?

2:30

Are today’s teens riding a slow boat to maturity? Compared to teens in the 1980s and 90s, this generation of teenagers are not in any hurry to grow-up, according to a new study.

In some ways, that’s a good thing. High school kids today are less likely to drink alcohol or have sex, compared to their counterparts a couple of decades ago.

However, they are also less likely to go on dates, have a part-time job or learn to drive – all conventional steps to adulthood.

Are these changes in development good or bad?  Actually, they are both, researchers said.  It depends on how you look at it.

Jean Twenge, a professor of Psychology at San Diego State University, said there are “trade offs’ to each path.

"The upside of slower development is that teens aren't growing up before they are ready," she said. "But the downside is, they go to college and into the workplace without as much experience with independence."

Being unprepared for work or college is definitely a problem for many of today’s adolescents, according to one specialist in teen mental health.

"I think if you ask any college professor, they'll tell you students these days are woefully unprepared in basic life skills," said Yamalis Diaz.

Diaz, who was not involved in the study, is a clinical assistant professor of child and adolescent psychiatry at NYU Langone Medical Center, in New York City.

Today's students may be sharp academically, Diaz said -- but they often have trouble with basics like planning, time management and problem solving.

The findings, published online in the journal Child Development, are based on nationally representative surveys done between 1976 and 2016. Together, they involved over 8 million U.S. kids aged 13 to 19.

On the upside, many of today’s teens aren’t attracted to activities that can be destructive such as drinking alcohol, drug and tobacco use and having sex at an early age. Those are important changes that bode well for young adults and make parents happy.

So why the change in attitude and priorities? It’s complicated. Technology has altered how many people, particularly teens, communicate. Many are spending less time in face-to- face conversations, choosing to text or post on social media.

Parenting styles have also seen a transformation. The “helicopter” or “hovering” parental style has gained in popularity. Some parents are involved so heavily in their kids’ lives that they make all the decisions for them and try to keep their kids from experiencing any type of failure.

In recent years, Diaz said, parents have become much more "child-centric," compared with the days when parents would send their kids outside with instructions to be back by dinner.

And while that is well-intended, Diaz said, kids today may have few chances to deal with relationships, work through their own problems -- and otherwise "stand on their own two feet."

"On one hand," Diaz said, "today's parents should be commended for sending their kids the right messages about what's appropriate for their age."

But, she added, "sometimes parents want to keep doing everything for their kids."

Diaz suggests that parents give kids the space they need to develop necessary skills, like problem-solving, time management and the ability to hold down a part-time job. She also advised parents to create some "no phone" time every day at home -- and to encourage their kids to do the same when they're with their friends.

Story source: Amy Norton, https://consumer.healthday.com/kids-health-information-23/adolescents-and-teen-health-news-719/are-today-s-teens-putting-the-brakes-on-adulthood-726634.html

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Fight the Flu

Fight the Flu

Your Teen

Most Parents Don’t Know Their Teen’s Vaccination Status

1:45

Most parents believe that they are on top of their kids’ immunizations, but that may not be true, especially where their teen is concerned.

Data from the Centers for Disease Control and Prevention (CDC) shows that adolescents are not getting all their recommended vaccinations, however, more than 90% of parents believe that their teenager had received all vaccinations necessary for their age, according to a C.S. Mott Children’s Hospital National Poll.

“In the United States, vaccines have long been recommended for babies and at kindergarten entry; more recently, several vaccines have been recommended for the adolescent age group,” Sarah J. Clark, MPHa research scientist from the Institute for Healthcare Policy & Innovation at the University of Michigan, and colleagues wrote. “However, data from the CDC indicate that national vaccination rates are well below public health targets, particularly those that require more than one dose, such as meningitis, human papillomavirus and annual influenza shots.”

The poll focused on vaccination for teenagers between 13 and 17 and included a national sample of parents.

Most parents had reported that their adolescent child had definitely (79%) or probably (14%) had all vaccinations recommended for their age, despite 36% of parents not knowing when their child is due for their next vaccine. The rest believed their child was due for their next vaccine within the next year (19%) or in more than a year (26%). One in five parents believed their teenager needed no more vaccines (19%).

The majority of parents polled relied on information about their child’s upcoming immunizations from their doctor’s office either through an office visit, scheduled appointment or a reminder that was sent. Rarely, would a notice be sent from the school, health plan or the public health department. A large number were not aware of how to be notified about upcoming vaccinations. 

"Parents rely on child health providers to guide them on vaccines in childhood and during the teen years,” Clark said in a press release. “Given the general lack of awareness about adolescent vaccines shown in this poll, there is a clear need for providers to be more proactive for their teen patients.”

Parents can be more proactive in finding out about their teens and younger children’s immunization requirements by checking their child’s school website or calling the school. The CDC also has a website with vaccination recommendations for children of all ages, including college students at https://www.cdc.gov/vaccines/schedules/index.html

The 2017-2018 school year will be here before you know it. Many schools will start up again in mid to late August. Do yourself and your child a huge favor by getting their immunizations up-to-date before the last minute rush!

Story source: https://www.healio.com/pediatrics/vaccine-preventable-diseases/news/online/%7Be6c9d80d-86d4-48a7-9090-b1e489e6db56%7D/majority-of-parents-unaware-of-teens-incomplete-vaccination-status

Your Teen

Overweight Girls Start Periods At Earlier Age

1.45 to read

Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases.It's nothing new that girls are getting younger and younger when they have their first period, but experts worry that the current obesity epidemic could be fueling that trend.

Overweight or obese girls get their first period months earlier than their normal-weight peers, according to a Danish study. Early-onset menstruation is linked to later health problems such as breast cancer, said Sarah Keim, a researcher at The Ohio State University College of Medicine in Columbus, who wasn't involved in the new study. Girls who get their period early in life are also more likely to have sex sooner than their peers, Keim added, which increases the risk of teen pregnancy and sexually transmitted diseases. About 17 percent of American kids and teens are obese, according to the Centers for Disease Control and Prevention. For the study, researchers used information on body mass index (BMI) -- a measure of weight in relation to height -- and age at first period from about 3,200 Danish girls born between 1984 and 1987. The girls started their period just after they had turned 13, on average, which is about half a year later than in the U.S. Keim said part of the reason for this difference may be that African-Americans tend to start their periods before white girls. On average, a girl got her period about 25 days earlier for every point her BMI increased. For a female of about average height and weight, a one-point change in BMI is equivalent to about six pounds. Overweight and obese girls, for example, got their period three to five months before normal-weight girls, said Anshu Shrestha, a graduate student at UCLA School of Public Health, who worked on the study. There has been past research showing a link between BMI and when girls start menstruating. However, since this study was done more recently, it shows that the link is holding up in today's generation, Keim said. The researchers also found that a girl's mother's weight was related to when her daughter started menstruating, but less so than earlier work had hinted. For every point her mother's BMI when pregnant went up, the girl's period came about a week earlier, according to the new study, which was published in the journal Fertility and Sterility. Keim said the Danish findings reinforce the importance of keeping a healthy weight. "It's important for your entire life, starting from very early on," she told Reuters Health. "And it can even affect your children's health." Talking to your daughter about Menstruation. Most girls begin to menstruate when they're about 12, but periods are possible as early as age 8. That's why explaining menstruation early is so important. But menstruation is an awkward subject to talk about, especially with preteen girls, who are often embarrassed by this discussion. So what's the best way to approach this ticklish topic? If your daughter asks questions about menstruation, answer them openly and honestly. Provide as many details as you think she needs at the time. It's OK to let your daughter set the pace, but don't let her avoid the topic entirely. If she's not asking questions as she approaches the preteen years, it's up to you to start talking about menstruation. Don't plan a single tell-all discussion. Instead, talk about the various issues - from basic hygiene to fear of the unknown - in a series of short conversations. Consider it part of a continuing conversation on how the human body works. Remember, your daughter needs good information about the menstrual cycle and all the other changes that puberty brings. If her friends are her only source of information, she may hear some nonsense and take it for fact. To introduce the subject of menstruation, you might ask your daughter what she knows about puberty. Clarify any misinformation and ask what questions she might have. It may be helpful to time your conversations with the health lessons and sex education your daughter is receiving in school, or you could broach the subject before a routine doctor's appointment. You can tell your daughter that the doctor may ask her whether she's gotten her period yet. Then ask if she has any questions or concerns about menstruation. Girls might prefer to learn about menstruation from a female family member, but sometimes that's not possible. If you're a single father and you're not comfortable talking about menstruation, you might delegate these conversations to a female relative or friend. The key is to make sure the information is relayed somehow. The biology of menstruation is important, but most girls are more interested in practical information about periods. Your daughter may want to know when it's going to happen, what it's going to feel like and what she'll need to do when the time comes. - What is menstruation? Menstruation means a girl's body is physically capable of becoming pregnant. Each month, one of the ovaries releases an egg. This is called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg isn't fertilized, the lining of the uterus sheds through the vagina. This is a period. - Does it hurt? Many girls have cramps, typically in the lower abdomen, when their periods begin. Cramps can be dull and achy or sharp and intense. Exercise, a heating pad or an over-the-counter pain reliever may help ease any discomfort. - When will it happen? No one can tell exactly when a girl will get her first period. Typically, however, girls begin menstruating about two years after their breasts begin to develop. Many girls experience a thin, white vaginal discharge about one year before menstruation begins. - What should I do? Explain how to use sanitary pads or tampons. Many girls are more comfortable starting with pads, but it's OK to use tampons right away. Remind your daughter that it may take some practice to get used to inserting tampons. Stock the bathroom with various types of sanitary products ahead of time. Encourage your daughter to experiment until she finds the product that works best for her. - What if I'm at school? Encourage your daughter to carry a few pads or tampons in her backpack or purse, just in case. Many school bathrooms have coin-operated dispensers for these products. The school nurse also may have supplies. - Will everyone know that I have my period? Assure your daughter that pads and tampons aren't visible through clothing. No one needs to know that she has her period. - What if blood leaks onto my pants? Offer your daughter practical suggestions for covering up stains until she's able to change clothes, such as tying a sweatshirt around her waist. You might also encourage your daughter to wear dark pants or shorts when she has her period, just in case. Your daughter may worry that she's not normal if she starts having periods before, or after, friends her age do, or if her periods aren't like those of her friends. But menstruation varies with the individual. Some girls have periods that last two days, while others have periods that last more than a week. It can even vary this drastically from month to month in the same girl. The amount of blood lost each month can vary, too, usually from 4 to 12 teaspoons (about 20 to 60 milliliters). It's also common for girls to have irregular periods for the first year or two. Some months might even go by without a period. Once your daughter's cycle settles down, teach her how to track her periods on a calendar. Eventually she may be able to predict when her periods will begin. Schedule a medical checkup for your daughter if: - Her periods last more than seven days - She has menstrual cramps that aren't relieved by over-the-counter medications - She's soaking more pads or tampons than usual - She's missing school or other activities because of painful or heavy periods - She goes three months without a period or suspects she may be pregnant - She hasn't started menstruating by age 15 The changes associated with puberty can be a little scary. Reassure your daughter that it's normal to feel apprehensive about menstruating, but it's nothing to be too worried about and you're there to answer any questions she may have.

Your Toddler

AAP: Winter Car Seat Safety

2:00

So far in Texas, this year’s El Nino weather pattern has made for a pretty mild winter compared to previous years. But, other areas around the country are being hit hard with a wintery punch and it’s only a matter of time till temperatures drop and snow and ice find their way to the Lone Star State.

Winter can be a bit tricky for child car seat use. While it sounds like the opposite might be true, bulky clothing such as coats and snowsuits should not be worn under the car seat harness.

More padding - more cushion right? That seems logical until you know what happens when a car crashes. In a wreck, fluffy padding immediately flattens out from the force, leaving extra space under the harness. A child can then slip through the straps and be thrown from the seat.

So how can you keep your little one warm and protected while buckled up? The American Academy of Pediatrics (AAP) has these tips to help strike a comfortable and safer balance.

·      Use a coat or blanket over the straps. You can add a blanket over the top of the harness straps or put your child's winter coat on backwards (over the buckled harness straps) after he or she is buckled up. Some parents prefer products such as poncho-style coats or jackets that zip down the sides so the back can flip forward over the harness. Keep in mind that the top layer should be removable so your baby doesn't get too hot after the car warms up.

·      Use a car seat cover ONLY if it does not have a layer under the baby. Nothing should ever go underneath your child's body or between her body and the harness straps. Be sure to leave baby's face uncovered to avoid trapped air and re-breathing. Many retailers carry car seat bundling products that are not safe to use in a car seat. Just because it's on the shelf at the store does not mean it is safe!

·      Dress your child in thin layers. Start with close-fitting layers on the bottom, like tights, leggings, and long-sleeved bodysuits. Then add pants and a warmer top, like a sweater or thermal-knit shirt. Your child can wear a thin fleece jacket over the top. In very cold weather, long underwear is also a warm and safe layering option. As a general rule of thumb, infants should wear one more layer than adults. If you have a hat and a coat on, your infant will probably need a hat, coat, and blanket.

·      Don't forget hats, mittens, and socks or booties. These help keep kids warm without interfering with car seat straps. If your child is a thumb sucker, consider half-gloves with open fingers or keep an extra pair or two of mittens handy — once they get wet they'll make your child colder rather than warmer.

·      Get an early start. If you're planning to head out the door with your baby in tow on winter mornings, you need an early start. You have a lot to assemble, and your baby may not be the most cooperative. Plus, driving in wintry conditions will require you to slow down and be extra cautious.

·      Tighten the straps of the car seat harness. Even if your child looks snuggly bundled up in the car seat, multiple layers may make it difficult to tighten the harness enough. If you can pinch the straps of the car seat harness, then it needs to be tightened to fit snugly against your child's chest.

·      Remember, if the item did not come with the car seat, it has not been crash tested and may interfere with the protection provided in a crash. Never use sleeping bag inserts or other stroller accessories in the car seat.

·      Store the carrier portion of infant seats inside the house when not in use. Keeping the seat at room temperature will reduce the loss of the child's body heat in the car.

·      Pack an emergency bag for your car. Keep extra blankets, dry clothing, hats and gloves, and non-perishable snacks in your car in case of an on-road emergency or your child gets wet on a winter outing.

·      Make sure your cell phone is charged. If there is an emergency, you want to be able to reach 911 or call for assistance in case of a flat tire or engine trouble.

This is a time when there is a lot of holiday travel from state to state or just down the road to grandma’s house.

Remember, it’s not just children in car seats whose coats shouldn’t be tucked under the harness, adults and older children should make sure their coats are on the outside of the seat-belt.

Little steps can make a big difference in everyone’s safety.

Source: https://healthychildren.org/English/safety-prevention/on-the-go/Pages/Winter-Car-Seat-Safety-Tips.aspx

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