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Daily Dose

Best Toys for Kids: No Batteries!

1.30 to read

I have been talking with my patients about gift ideas for the holidays and I had an epiphany!!  I think this season we should all try to buy children’s toys with the slogan “no batteries required”.  This is a great idea for children of all ages, even for my “almost adult” children.  By going back to basics and skipping the electronics I am certain that there will be more family time, maybe face to face, rather than having your child’s face staring at yet another screen.

So with that in mind I have polled patients/parents on toy ideas that will fit the “no batteries required”. Top of the list would be blocks for toddlers through pre-schoolers.  A good set of blocks will last a lifetime and you can add on to the set each year.  Blocks also work well for both boys and girls and siblings can play together and use their imagination to build towers, forts and cities. Children can easily spend hours with a set of different shaped and sized blocks.

Along the same line as blocks, but for older children are the classic Lego sets. I still have tubs of Lego’s in our house that I hope will one day be used by grand children. What a great way to learn to basic engineering as well as fine motor skills while putting a Lego set together. From beginner to adult, there are sets for all ages.  One of my pediatric partners still loves to build and has the Empire State building and Eifel Tower on display in his office.

Games are always a great gift. The classics like Candyland, Chutes and Ladders, Clue and Monopoly. What about checkers, chess and our family favorite (at least mine) Rummikub.  I still love to have “family game night” and the boys will humor me and play a few games before slowly begging off.

What about card games as well, from Go Fish for the preschool child to bridge for the teen (I am still taking lessons!)? The kids all still love to play Spades and Hearts and we also play a lot of Onze during the holidays. Cards work for all generations too and are a great way to keep everyone engaged.

Lastly, what about some crafts. Crayons and markers and coloring books can be just as much fun as fancy Apps for coloring on the I-pad. Learning to color between the lines and hold the crayon are great exercises in fine motor skills as well. Not sure you get the same benefit on the screen version? Teaching a child how to weave, or use scissors to cut strips of paper to make chains to decorate the house for the holidays. There are also some fun sewing crafts too. Good way to teach your child how to hem and sew on a button as well, which are definitely life skills!

So this year, think about trying the “no batteries required” idea. I am sure you too have your old favorites. But, you may have to exchange a few gifts before Christmas???

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

 

 

Daily Dose

Power of Medical Attorney While Away

When you're out of town, make sure you prepare a medical power of attorney for your child's caregiver in case of an emergency.It is the time of year for family vacations and I have noticed many parents are also opting for a little vacation time for themselves too! (I tell my patients it’s important).  I have recently seen a number of grandparents and family babysitters bringing their “charges” into the office for a visit while mom and dad are out of town.

Have you prepared a temporary power of attorney so that in case of am emergency your child can receive medical care when you leave town? In reality, you should always leave a notarized letter that states who legally has the right to seek medical care for your children. Why does it seem like a 2 year old always gets a fever within 2 days of their parent’s departure?  While your long standing pediatrician may not require this document to see your child for an office visit while they are under the care of grandparents, there are times when it might really be needed. If your child needed surgery, stitches or even a trip to the ER to rule out a broken arm, the emergency room will require the letter that states that the caregiver in question has the authority to seek medical care for the under age child. In most cases a parent could be reached by cell phone, even in very remote areas of the world, but on the occasion that the parents cannot be reached this document will be needed. So, why not be prepared? We used to leave the letter on the front of the refrigerator with the names of everyone that might have the need to take our child to the hospital or doctor. The same letter was there for years, and included not only the grandparent’s names, but also friends and neighbors who would be available if necessary.  We had it notarized and updated as necessary, and thankfully I don’t think it was ever used. (My children always seemed to get hurt with me around!) Before leaving for an adult trip, you should leave the numbers of the pediatrician, the dentist, and any other doctors that your child routinely sees. It is also helpful to leave a copy of the medical insurance card! Seems you can’t do anything without it! Lastly, include the phone number for your pharmacy. For the very organized, you might also leave directions on how to get to the doctor, pharmacy or hospital etc. I have drawn many a rudimentary map for a lost grandparent who is now going to have to head from my office to the pharmacy to get the pink medicine filled. In most cases, the child is already well before the parents even return! That's your daily dose for today.  We'll chat again tomorrow.

Your Teen

More Teens Fall Victim to Dating Violence

2:00

The teenage years are supposed to be filled with laughter, fun and testing the boundaries of parental control. It’s also a time when many boys and girls will start dating. For some teens, the beginning of couple relationships is about as far away from fun as it could possibly be.

Some teenagers may think that teasing and name-calling are somehow linked with a fondness for someone, and that might have been true when they were six or seven years old. However, by the time a young girl or boy reaches their teenage years, that kind of behavior can take on a much different tone. What was once an awkward attempt at gaining someone’s attention can turn into physical and sexual abuse.

According to a new study from the Centers for Disease Control and Prevention (CDC) that is happening more than you might think.

Twenty-one percent of high school girls have been physically or sexually assaulted by someone they dated -- a figure twice as high as previously estimated.

Ten percent of high school boys also reported being physically or sexually assaulted by someone they had dated.

The authors of the new report noted that the CDC has changed the way it phrases its questions about teen dating violence, leading more students to report assaults.

Sadly, teens that have experienced dating violence are at risk for other serious problems as well. Research has shown that they are more than twice as likely to consider suicide. They are also more likely to get into fights, carry a weapon, use alcohol, marijuana or cocaine and to have sex with multiple partners. Not the kind of life any parent would want for their teenager or the one that they would truly want for themselves.  

Researchers don't know if any of these events causes the others. While it's possible that dating violence could cause thoughts of suicide, it's also possible that children who are depressed are more likely than others to fall into abusive relationships, says Adiaha Spinks-Franklin, a developmental and behavioral pediatrician at Texas Children's Hospital in Houston who was not involved in the study.

Assaults by romantic partners often aren't isolated events. Many teens reported being assaulted multiple times, according to the study, based on the CDC's Youth Behavior Risk Surveillance System using questionnaires answered by more than 13,000 high school students.

"If there is violence once, there is likely to be violence again," Spinks-Franklin says. "It has to be taken very seriously."

Spinks-Franklin says she has seen violence even among relationships between 10- and 11-year-olds.

"If a parent is concerned that a child is in an unhealthy relationship, they need to address it, but do it in a way that doesn't make the child shut down," she says. "They need to feel safe telling a parent."

Teens often hide the abuse from their parents, Spinks-Franklin says. Teens may not be able to confide in friends, either, because abusers sometimes isolate their victims from loved ones. Teens are sometimes more willing to talk to doctors, especially if their parents are not in the room.

Some schools have taken the lead in promoting awareness of and education on teen dating violence. Pediatricians can also discuss this important topic with their patients and parents. If time is limited, brochures in the waiting room can offer information and open the door for questions.

"This study makes it even more important for parents to ask lots of questions and get to know their teen's friends and significant others, and not ignore anything that makes them uncomfortable," says McCarthy, a pediatrician at Boston Children's Hospital. "They also shouldn't ignore any changes in their teen's behavior."

Dating violence may never be eliminated one hundred percent, but can be considerably lessoned when teens, families, organizations, and communities work together to implement effective prevention strategies.

One of the best strategies for prevention is for parents and teens to be able to communicate about serious topics without judgmental attitudes or closed-minded opinions. Your teen wants your help even if he or she doesn’t know how to ask. They'll appreciate you being there before and when they need you.

The new study was published in JAMA Pediatrics.

Sources: Liz Szabo, http://www.usatoday.com/story/news/2015/03/02/teen-dating-violence-study/24127121/

http://www.cdc.gov/violenceprevention/intimatepartnerviolence/teen_dating_violence.html

Your Child

Doctors May Unknowingly Discourage HPV Vaccine for Preteens

2:00

The majority of physicians say that the HPV vaccine given to preteens, before they become sexually active, can help prevent infections with viruses that can cause cervical, penile and anal cancers as well as genital warts.

However, about 27 percent of doctors may inadvertently discourage parents from having their preteens vaccinated against human papillomavirus (HPV), according to a new study, because they don’t recommend the vaccine strongly enough.

Pediatricians and family physicians deliver the bulk of HPV vaccines. Some of these physicians do not offer the vaccines as strongly as they do when urging parents to vaccinate against meningococcal disease or to get tetanus, diphtheria, and pertussis booster shots, the study reported.

The study, which is based on a national online survey of 776 doctors, found a quarter did not strongly endorse the need for HPV vaccination with the parents of the 11- and 12-year-olds under their care.

Nearly 60 percent were more likely to recommend the vaccine for adolescents they thought were at higher risk of becoming infected — perhaps because the doctors knew or suspected they were sexually active — than for all 11- and 12-year-olds.

“You kind of get the sense that some [health care] providers see this as a somewhat uncomfortable situation,” said lead author Melissa Gilkey, a behavioral scientist in the department of population medicine at Harvard Medical School.

Many parents don’t like to think about the possibility of their child having sex, particularly when they are only 11 or 12 years old. The vaccine is actually meant to provide protection for when they are older. That’s why it is recommended before a child typically begins engaging in sexual activity. Studies have also shown preteens get the best immune response to the vaccines.

Evidence generated by one of Gilkey’s earlier studies suggests it’s not necessarily parents that are squeamish about the vaccination, but physicians that overestimate a parent’s response when the vaccination is urged. 

 “It’s not necessarily that physicians always are negative about it. But it’s kind of that HPV vaccine may get damned with faint praise, if you will,” Gilkey said. “Compared to the way that they recommend these other vaccines, parents may suspect that there’s something wrong with it.”

The aim of the research is to help figure out why HPV vaccination rates remain disappointingly low. The CDC reported that in 2014, 40 percent of adolescent girls and 22 percent of adolescent boys had received the recommended three doses of HPV vaccine. The agency says girls and boys should have all three doses by their 13th birthday.

According to the study, how the information is presented has an impact on how well it is received. Doctors who started conversations about the HPV vaccination by telling parents the vaccines protect against cancers and genital warts gave stronger recommendations than those who opened saying HPV viruses are sexually transmitted.

The study was published Thursday in Cancer Epidemiology, Biomarkers and Prevention, a journal of the American Association for Cancer Research.

Although Gilkey declared no conflicts of interest, the senior author of the study, Noel Brewer of the University of North Carolina, has received research funding and speaker fees from companies that sell HPV vaccines.

Source: Helen Branswell, https://www.bostonglobe.com/lifestyle/health-wellness/2015/10/21/study-says-doctors-inadvertently-discourage-hpv-vaccines/LuJaMFoEupeOeYrrUOlYRN/story.html

 

 

 

 

 

Your Baby

Teething May Make Your Baby Fussy, But Not Sick

2:00

Parents sometimes have trouble distinguishing between whether their cranky baby is actually ill or is just getting his or her first teeth. Because a baby’s gums may be tender and swollen as their teeth come in, a slight rise in temperature can occur.  Other changes may happen as well such as fussiness and increased drooling. All- in –all, babies can be pretty miserable till those first teeth break through.

That said, teething does not cause a full-fledged fever above 100.4 degrees Fahrenheit or any other signs of illness according to a new review led by Dr. Michele Bolan, of the Federal University of Santa Catarina, Brazil.

Certain symptoms can be confusing for parents says Dr. Minu George, interim chief of general pediatrics at Cohen Children's Medical Center, in New Hyde Park, N.Y.

"I get questions about this on a daily basis," said George, who was not involved in the study.

When a baby’s temperature reaches 100.4 degrees F or higher, it becomes an actual fever, not just a slight increase in temperature.

"Fevers are not a bad thing," she pointed out. "They're part of the body's response to infection." But, George added, parents should be aware that a fever is likely related to an illness.

Of course, new parents are going to be somewhat edgy when it comes to caring for their infant. It’s a new world of responsibility that can seem overwhelming at times. 

Pediatricians and family doctors regularly answer questions about this topic with an explanation of how a typical teething experience presents.

Over the ages, other symptoms have been linked to teething that should never apply. They include sores or blisters around the mouth, appetite loss and diarrhea that does not go away quickly. Any of these symptoms warrant a call to your pediatrician.

Babies differ in age as to when their teeth begin to come in.  Typically, the fist tooth begins to erupt around 6 months of age. It can also be as early as 3 months and as late as 1 year of age. There really isn’t a set age for teething to begin, just an average.

Baby’s teeth usually erupt through the gums in a certain order:

·      The two bottom front teeth (central incisors)

·      The four upper front teeth (central and lateral incisors)

·      The two lower lateral incisors

·      The first molars

·      The four canines (located on either side next to the upper and lower lateral incisors)

·      The remaining molars on either side of the existing line of teeth

By age 3, most children have all 20 of their primary teeth.

As for helping babies get through the misery of teething, George advised against medication, including topical gels and products that are labeled "natural" or "homeopathic."

Instead, she said, babies can find relief by chewing on a cooled teething ring or wet washcloth, or eating cool foods.

The analysis was published in the February online edition of the journal Pediatrics.

Sources: Amy Norton, http://www.webmd.com/parenting/baby/news/20160218/teething-makes-babies-cranky-but-not-sick-review

http://www.webmd.com/parenting/baby/tc/teething-topic-overview

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

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Asthma

Managing Your Child's Asthma

Your Baby

Baby's First Tooth!

Many dentists like to see a child by age one, not because there are a lot of problems to detect, but because it’s a good time to help parents learn more about dental health care and to establish a good relationship with the child.After all the crying, and teething fits, midnight trips to the crib, and endless time soothing and rubbing gums.... it’s finally here. Baby’s first tooth!  It’s also time to start thinking about your child’s dental health, and baby’s first visit to the Dentist.

It is generally recommended that an infant sees a dentist by the age of 1 or within 6 months after his or her first tooth comes in.

Many dentists like to see a child by age one, not because there are a lot of problems to detect, but because it’s a good time to help parents learn more about dental health care and to establish a good relationship with the child. The average age for continuing visits is about 2 to 2.5 years old depending on your child’s dental heredity and overall health. Many dentists like to see children every 6 months to build up the child's comfort and confidence level in visiting the dentist, to monitor the development of the teeth, and promptly treat any developing problems. What Happens at the First Dental Visit? The first dental visit is usually short and involves very little treatment. This visit gives your child an opportunity to meet the dentist in a non-threatening and friendly way. Some dentists may ask the parent to sit in the dental chair and hold their child during the examination. The parent may also be asked to wait in the reception area during part of the visit so that a relationship can be built between your child and your dentist. During the exam, your dentist should check all of your child's existing teeth for decay, examine your child's bite, and look for any potential problems with the gums, jaw, and oral tissues. If indicated, the dentist or hygienist will clean any teeth and assess the need for fluoride. He or she will also educate parents about oral health basics for children and discuss dental developmental issues and answer any questions. Topics your dentist may discuss with you might include: 1. Good oral hygiene practices for your child's teeth and gums and cavity prevention 2. Fluoride needs 3. Oral habits such as thumb sucking, tongue thrusting, lip sucking. 4.  Developmental milestones 5. Teething 6. Proper nutrition You will be asked to complete medical and health information forms concerning the child during the first visit. Come prepared with the necessary information. What's the Difference Between a Pediatric Dentist and a Regular Dentist? A pediatric dentist has at least two additional years of training beyond dental school. The additional training focuses on management and treatment of a child's developing teeth, child behavior, physical growth and development, and the special needs of children's dentistry. Although either type of dentist is capable of addressing your child's oral health care needs, a pediatric dentist, his or her staff, and even the office décor are all geared to care for children and to put them at ease. If your child has special needs, care from a pediatric dentist should be considered. Ask your dentist or your child's doctor what he or she recommends for your child. When Should Children Get Their First Dental X-Ray? There are no hard-and-fast rules for when to start dental X-rays. Some children who may be at higher risk for dental problems. Children prone to baby bottle tooth decay or those with cleft lip or palate should have X-rays taken earlier than others. Usually, most children will have had X-rays taken by the age of 5 or 6. As children begin to get their adult teeth around the age of 6, X-rays play an important role in helping your dentist. X-rays allow your dentist to see if all of the adult teeth are growing in the jaw, to look for bite problems and to determine if teeth are clean and healthy. Once a child’s diet includes anything besides breast-milk or baby formula, erupted teeth are at risk for decay. The earlier the dental visit, the better the chance of preventing dental problems. Children with healthy teeth chew food easily and smile with confidence. Start your child now on a lifetime of good dental habits.

Daily Dose

Celebrate Earth Day

1.30 to read

Last week was a really hard week for our entire country.  Thankfully we are starting off this week on an entirely different note, with Earth Day celebrations.  Today is the day that over one billion people around the world unite to “voice concerns for the planet, and to take action to protect it.”

The global theme for Earth Day 2013 is “The Face of Climate Change”, which is highlighting the impact of climate change on every person around the world. Not only are we seeing issues with global warming (the United States experienced the hottest year ever in 2012), but news stories continue to report massive weather events around the world. From super storms, to droughts in some parts of the world to flooding in others, international climate changes impact all of us.....and our children.

Earth Day activities are taking place in approximately 192 countries, making it “the largest civic observance in the world”.  What a great lesson to begin teaching our children!  While the challenge to save our environment is global, simple actions that we can take on a daily basis will be the start of initiating individual changes to save the planet for the next generations.

So, think of one thing you and your family can do today to impact environmental change.  Whether that is turning off lights and electronics when you leave home, walking to school rather than driving, beginning a recycling program in your home.....to larger projects within your community, every small contribution will lead to the greater good.

I know I have watched our country come together over the last week due to tragic events in both Boston, MA and West, TX. While we face many differences in beliefs within the United States, and worldwide, protecting the Earth is one challenge that knows no boundaries.  

Spend some time today discussing earth day, and model some “green” behavior for your child. The future of our children depends on this.

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