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Daily Dose

Media Exposure is Everywhere

1.15 to read

It’s interesting how many new topics there are to discuss during a child’s check up. I am sure that 10-15 years ago, I was not spending a part of each child’s well visit discussing “screen time”. I begin this discussion early on, even before the child is “watching TV” as a child under the age of 2 gets a lot of “secondhand” media exposure. 

I find that some new parents have the TV on all day, tuned into CNN or CNBC (just to name a few) and the images on the screen are often not age appropriate nor is the language. Suddenly their toddler is asking about death, tornadoes, wars and carnage. A 2 year old is too young to understand a lot of this, but they know it is scary.  They may also develop sleep disturbances as this age related to the scary images. 

As the child is older, the images flashing across the news screen all day continue. But the older child can grasp the concepts a bit better, but instead of being truly scared, they become anxious.  I see too many 5- 0 year old children who now worry that the approaching thunderstorm means a tornado, or going to school might mean getting shot.  Although these types of tragedies are all too real, fortunately they are not a day-to-day occurrence and I don’t think an elementary age child needs to be afraid to leave their parent’s to go to school for fear of being shot. 

The same goes for the older child. Many of my tween and teen patients have a TV in their bedroom. (I ask this question at every visit beginning at age 2). I often hear that “their TV is not connected to cable”. It is not only the cable channels anymore that have inappropriate content for children of all ages. 

The tween is bombarded by live news images of children being killed around the world, or of sexually explicit images as well. Even a “good vigilant” parent cannot always know what their 14 old might find on the TV that is in their own room. 

I can’t tell you how many times a day I recommend that a parent take the TV out of their child’s bedroom. Some parents think I am crazy, and many teens want to duct tape my mouth shut, but study after study shows that there is no need for media in a child’s room. I even hear that the child “earned the TV for good behavior. Reward their behavior in another way! I tell all of my patients that they can have a TV in their own room, (gasps from some parents while I say that), but they will be in their own college dorm or home before they do. 

Remember to try and limit your child’s screen time to less than 1-2 hours/day, (even if only as secondhand media). Watch TV with your child and discuss the content in an age appropriate manner.  Lastly, keep the media in the family room and not a child’s bedroom. 

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

Daily Dose

New Year New You

1:30 to read

With the New Year upon us what better time to talk about changing some habits.  Why is it that habits are certainly easy to acquire, but difficult to change?  I saw a book on The New York Times Bestseller list about “Habits” and I am committed to reading it this year.  

I know that we started many “bad” habits when my husband and I were new parents, and I talk to my patients every day about not doing the same things I did.....but, even with that knowledge there are several recurrent habits that I wish parents would try to change....or better yet, don’t start.

Here you go!

#1  Do not have your baby/child sleep with you  (unless they are sick).  This is a recurrent theme in my practice and the conversation typically starts when a parent complains that “I am not getting enough sleep, my child wakes me up all night long”.  Whether that means getting in the habit of breast feeding your child all night long, or having your two year old “refuse” to go to sleep without you...children need to be independent sleepers. Some children are born to be good sleepers while others require “learning” to sleep, but either way your child needs to know how to sleep alone. I promise you...their college roommate will one day thank you.

#2  Poor eating habits.  Family meals are a must and healthy eating starts with parents (do you see a recurrent theme?). I still have parents, with 2, 3 or 4 children who are “short order cooks” which means they make a different meal for everyone.  Who even has the time?  Sounds exhausting!!  Even cooking 2 meals (breakfast, dinner) a day for a family is hard to do for 20 years, but enabling your children to have poor eating habits by only serving “their 4 favorite foods- is setting them up for a lifetime of picky and typically unhealthy eating.  Start serving one nutritious family dinner and let everyone have one night a week to help select the meal. Beyond that, everyone eats the same thing.  Easy!  If they are hungry they will eat.

#3  No electronics in your child’s room. If you start this habit from the beginning it will be easy....if you have a TV in your child’s room when they are 6-8, good luck taking it out when they are 13-15.  First TV in their room should be in a college dorm.  For older children make sure that you are docking their electronics outside of their rooms for the night. Everyone will sleep better!

These may sound easy....so give it a try.  

Happy New Year!

 

 

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

Your Child

Making Sure Public Pools Are Safe

1:30

With temperatures on the rise, it wont be long before families start heading to the nearest public pool to cool down; however, some public pools may pose a serious health hazard.

Each year, thousands of public pools, hot tubs, and water playgrounds are forced to close due to serious health and safety violations, including contamination problems that could make people sick, according to a recently released report from the Centers for Disease Control and Prevention (CDC).

Swimming is one of the best exercises you can participate in and it’s a lot of fun. Health officials say they don’t want to discourage people from swimming, but that individuals should be aware of certain issues with public pools and know what steps they can take to make sure their families are safe.

"No one should get sick or hurt when visiting a public pool, hot tub, or water playground," Dr. Beth Bell, director of CDC's National Center for Emerging and Zoonotic Infectious Diseases, said in a statement. "That's why public health and aquatics professionals work together to improve the operation and maintenance of these public places so people will be healthy and safe when they swim."

For the report, the CDC collected data in the five states with the most public pools and hot tubs -- Arizona, California, Florida, New York, and Texas in 2013. They reviewed over 84,000 routine inspections of nearly 50,000 public pools, hot tubs, and water playgrounds.

The results showed that almost 80 percent of all inspections identified at least one violation, with 1 in 8 inspections resulting in immediate closure because of serious health and safety problems.

The highest proportion of closures were in "kiddie" or wading pools, with 1 in 5 needing to be closed down.

The most common violations were improper pH levels, lack of safety equipment and inadequate disinfectant concentration. The correct pH level is critical for killing germs.

Pools contaminated with fecal matter pose a direct threat to health. This usually occurs when people suffering from diarrhea go in to a pool or when fecal matter washes off of children or leaks from dirty diapers.

Officials suggest that parents check their children’s diapers and take them for regular bathroom breaks. Swim diapers do not prevent feces, urine, or infectious pathogens from contaminating the water, the authors note.

To check the pH level of any pool you enter, you can use a pool water test strip.

The CDC recommends the following levels:

·      Free chlorine concentration of at least 1 ppm in pools and at least 3 ppm in hot tubs/spas.

·      Free bromine concentration of at least 3 ppm in pools and at least 4 ppm in hot tubs/spas.

·      pH of 7.2-7.8.

Another safety hazard is improper drain covers. Make sure that the drain cover appears secure and is not in need of repair.

While some public pools provide lifeguards, not all do. Check to see if your neighborhood pool has a lifeguard trained in CPR. Even if your pool does provide a lifeguard, keep your eyes on your children at all times. The more people watching out for your child, the better.

If you find any problems, avoid getting into the water and tell someone in charge so the problems can be fixed.

"Environmental health practitioners, or public health inspectors, play a very important role in protecting public health. However, almost one third of local health departments do not regulate, inspect, or license public pools, hot tubs, and water playgrounds," said Dr. Michele Hlavsa, chief of CDC's Healthy Swimming Program. "We should all check for inspection results online or on site before using public pools, hot tubs, or water playgrounds and do our own inspection before getting into the water"

Checking the pool you swim in for contamination and other safety issues is good advice for anyone using a pool, whether it’s public or private. Pool test strips are available online or at superstores, such as Walmart, Lowes and Home Depot.

Story source: Ashley Welch, http://www.cbsnews.com/news/alarming-number-of-public-pools-cited-for-health-violations-cdc/

Daily Dose

Traveling With Children

1:30 to read

I was traveling last week and encountered many families with young kids who were also flying to  sun and snow for spring break. I was traveling by myself and realized just how “difficult” it has gotten to fly with young children. It was hard enough years ago….but with security lines, full flights, and lots of flight delays as well…..a trip with babies, and toddlers and even some older children can be a bit of a “nightmare”.

So my flight home was delayed by 3 hours, which while irritating, was not too difficult as I was alone and can find lots to entertain myself with in an airport. Unfortunately, I was in a smaller airport, but it did make it easy to people watch. And, there were lots of families traveling, so it was like a tutorial in child development and parenting while watching everyone.

Three hours is a long time to wait, but I was amazed by a few of the young families I saw who were doing their best to entertain their children. Going back through security just for a change in scenery did not seem like an option for most as they would have to take all of that “gear” off their kids and “re-dress” on the other side again. But, you can only walk back and forth from the gate, to the restaurant, then the bathroom a few hundred times before that gets old as well. 

So, most of the families had resorted to pulling out their I-phone or computer to entertain their children and everyone was “wired” up.  But there was one young mother and father who sat on the floor and played with their daughter…pat a cake, peak a boo, hide and seek around the chairs, read books, ate snacks  (all of which looked really healthy), talked about different airplanes and where they were all going…on and on for 3 hours.  I was really rather in awe at how they made it “look easy” to entertain a toddler in an airport.

Just as they finally announced that we would be boarding their daughter started getting as tired, cranky and irritated as many of the adult travelers around her. As her mother explained to those around her,  her daughter had missed her nap, really had not had lunch and was just as bored and tired as everyone else….all of which made a great deal of sense.  So, as I  took my seat, I looked over they were seated right across from me…and I thought to myself…this is going to be a long 2.5 hour flight after our delay.

But once they got their daughter situated and we had taken off her mother pulled out an I-pad and had loaded a movie for her daughter to watch. The little girl (she was about 2 1/2 yrs)  sat quietly for the entire flight. I was AMAZED.

After we landed I was speaking to this family again and commented on how well behaved their daughter had been and how she sat quietly and watched the movie. Her mother replied, “ she never gets to use electronics except for a plane ride…not even while waiting for a flight with a 3 hour delay!!!”  WOW - I had to applaud them, they did not use electronic media as a “babysitter” and were committed keeping it that way for as long as possible. Good role models for parenting!

 

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Daily Dose

2016 Goals

1:15 to read

Just finished cleaning up after the Christmas holidays and I resolved that I was going to “de-construct” the decorations before the next holiday…and not have to face the New Year with that task looming.  Now I can move on to some different resolutions!

The more and more that I realize how much time we all spend “hunched” over a screen of some sort, the more I think that this year should be about finding time to disconnect.  It used to be that you could just turn off your phone when you wanted to be “unavailable”.  That seemed so easy…people would just have to call back later, right?  But now we try text, email, g-chat, face time….all sorts of ways to try to connect.  It is much harder to be on the DL or unavailable. 

I continue to read new data on the need for personal communication via oral language, rather than a text or email. But the immediacy of communication these days makes it seem that we don’t talk any more, we just type!!  This is even becoming an issue for younger and younger children as they focus on their “baby”computers and screens that are given to them to watch…rather than on their parents and caregivers faces and interactive language.  There is already data to show that the interaction with a screen is not the same as that with a human….and that language may even be delayed.

So the point of this is that my resolution is to take time everyday to just disconnect from a screen and enjoy a bit of old fashioned solitude and quiet time.  I am going to get up each day and not rush to the computer to check any “late breaking” emails from overnight.  I am also  going to turn off the I-phone which as they taught me early on at the Apple store, is not really a phone but rather a hand held computer!  I hope that there may be an hour every morning and another in the evening when I am totally disconnected….I’ll let you know how I do. Don’t worry if you can’t “find” me….I am just off the grid.

What are your resolutions?

Daily Dose

Politics & Vaccines

1:30 to read

As we head into another election cycle, I bet many of you watched the recent GOP debates (23.1 million viewers).  I too was watching and listening, but I must say my ears perked up when I heard several of the candidates discuss the issue of childhood vaccines.  Suddenly I was hearing politicians or political “wanna bees” discussing whether or not children should receive vaccines?  I held my breath as I heard several of the candidates, some of whom are even physicians who presumably understand science, discuss vaccine safety, alternative vaccine schedules and the relationship of vaccines to autism.

I truly was aghast to hear Donald Trump discuss his anecdote of a child who purportedly had their vaccines and suddenly “became autistic” (which is a diagnosis made over time). Then there was Dr. Ben Carson, a pediatric neurosurgeon who stated  “we are probably giving way too many vaccines in too short a period of time”.  Had he forgotten children with meningitis?  As I sat in front of the TV and groaned I heard Dr. Rand Paul add, “vaccines are one of the greatest medical discoveries of all time, but even if science doesn’t doesn’t say bunching them up is a problem, you ought to be able to spread vaccines out a little bit”. Has he done a study to show that alternative schedules work?

Many of their statements were based on “faulty logic”, and had “no scientific basis” and some were entirely anecdotal. Numerous studies from around the world have proven that there is no link between vaccines and autism. Vaccines have only gotten safer and are essential for public health.  Stick to the facts…were the fact checkers watching?  Where was the rebuttal?

As a pediatrician who discusses vaccines with patients on a daily basis I must say I was horrified by these statements.  If politicians want to weigh in on childhood vaccines then it is incumbent upon them to be “briefed” and up to speed about the science behind the childhood vaccine schedule and vaccine safety.   While they are learning about foreign policy, economic decision making and the recent issues surrounding global immigration ( all of which seem to be more of a political policy issue than childhood vaccines) maybe they need a crash course in public health.  Misinformation about vaccines from those who have a national television audience is unacceptable. Having a child “go un-immunized”  due to statements that were made during  the GOP debate, has the potential to harm many children. Just look at the recent measles outbreak….these are serious issues. 

The president of the AAP quickly released a statement endorsing the childhood vaccination schedule, the importance of vaccines and vaccine safety. Many pediatricians as well as other physicians have also re-iterated the importance of vaccines being given according to the vaccine schedule. As Dr. Remley stated, “what is best for children is to be fully immunized”. plain and simple. I am hopeful that the 23 million debate watchers heard her message.

Your Baby

Ditch the Smartphone Apps to Monitor Baby’s Health

1:45

If you use a smartphone app to monitor your baby’s vital signs, a new research paper suggests that you may want to send those apps to trash.

The apps are linked to sensors in a baby’s clothing and are marketed as a way to help parents be aware of things like breathing, pulse rate and oxygen levels in the blood and sound alarms when infants are in distress. But they aren't tested or approved for U.S. sale like medical devices and there's little evidence to suggest these monitors are safe or effective, said Dr. Christopher Bonafide, lead author of the opinion piece in JAMA; an international peer-reviewed medical journal.

"I’ve been there myself, peeking in the door of my son’s room late at night, making sure I could hear him breathing," Bonafide, a pediatrics researcher at the University of Pennsylvania and Children's Hospital of Philadelphia, said by email to Reuters.

Marketing ads of the monitors stop short of saying they can diagnose, treat or prevent illnesses, however, they do promise parents peace of mind that comes from an early warning system when something is wrong with babies' health, the study authors write.

Promotions for some apps also play into parents’ fear of SIDS (sudden infant death syndrome), suggesting that parents can have peace of mind that their baby is just sleeping,

The AAP advises parents not to use monitors like the ones paired with smartphone apps for home use because there's no evidence this reduces the risk of SIDS.

Instead, parents should rely on prevention efforts proven to work, like breastfeeding and sleeping in the same room with their babies, the AAP recommends.

"Perhaps in the future there may be a technology that is in development to lower the risk of SIDS," said Dr. Lori Feldman-Winter, a co-author of the AAP guidelines and pediatrics researcher at Cooper Medical School of Rowan University in Camden, New Jersey.

"However, we are not there yet," Feldman-Winter - who wasn't involved in the paper, - added in an email to Reuters.

Sometimes, we as consumers, assume that if something is for sale- particularly a health related item- that it has been approved or tested by a U.S. governmental agency. That’s not always the case. Smartphone applications can be created and sold relatively easily these days without any assurance the app actually performs as promoted. Parents of newborns are a good market for anything that promises to keep their baby safe.

New smartphone-integrated monitors currently available in the U.S. or expected to debut soon include Baby Vida, MonBaby, Owlet, Snuza Pico and Sproutling.

Some pediatric health experts express concern that using apps to monitor a baby’s health actually reduces the parent’s ability to know their own baby’s unique habits, body and cues that he or she may be in distress.

"We have lost sight of what babies need in order to keep them safe, and many parents and grandparents today do not realize that it is the presence of a responsive and vigilant caregiver that keeps a baby safe, but believe the job can be outsourced to a smartphone/video-monitor/technomattress etc," said Helen Ball, director of the Parent-Infant Sleep Lab at Durham University in the UK, in an email. Ball was not involved in the paper.

Ball believes that the best way to keep our babies’ safe is to use our eyes, ears and touch to respond to and monitor for any health concerns.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-safety-baby-monitors-idUSKBN1582RA

http://jamanetwork.com/journals/jama/article-abstract/2598780

Your Teen

Websites May Encourage Self-Injury

1.45 to read

The videos may be a focus for communities of youth in which self-injury is encouraged and viewed as normal and exciting, which could potentially increase the risk for self-injury.Some at-risk teens are finding new ways to hurt themselves thanks to a popular website with videos that glorify self-injury.

Young adults and teens may believe that hurting themselves is normal and acceptable after watching videos and other media on Web-sharing sites like YouTube, new research indicates. The findings, published in the journal Pediatrics, warn professionals and parents to be aware of the availability and dangers of such material for at-risk teens and young adults. Deliberate self-injury without the intent of committing suicide is called “non-suicidal self-injury” or NSSI. An estimated 14% to 24% of youth and young adults engage in this destructive behavior, according to the study. NSSI can also include relationship challenges, mental health symptoms, and risk for suicide and death, the study noted. Common forms of self-injury include cutting, burning, picking and embedding objects to cause pain or harm. While other studies have looked at the availability of online information about self-injury, the authors focused on the scope of self-injury in videos uploaded on YouTube and watched by youth. They described their work as the first such study and noted that their findings could be relevant in risk, prevention and managing self-injury. The authors focused on YouTube because, according to the site, since its inception in 2005 “YouTube is the world's most popular online video community, allowing millions of people to discover, watch and share originally-created videos.” Using the site’s search function the researchers looked for the terms “self-harm” and “self-injury,” identifying the site’s top 50 viewed videos containing a live person, and the top 50 viewed videos with words and photos or visual elements. The top 100 items that the study focused on were viewed over 2 million times, according to the analysis, and most – 80% - were available to a general audience. The analysis of the self-injury content found that 53% was delivered in a factual or educational tone, while 51% was delivered in a melancholic tone. Pictures and videos commonly showed explicit demonstrations of the self-harming behavior. Cutting was the most common type of behavior; more than half of the videos did not contain warnings about the graphic nature of the behavior. The average age of uploaders of the self-injury material was 25.39 years, according to the findings, and 95% were female. The authors surmise that the actual average age is probably younger because many YouTube users say they are older in order to access more content. The study concludes that the findings about the volume and nature of self-injury content on YouTube show "an alarming new trend among youth and young adults and a significant issue for researchers and mental health workers." The videos may be a focus for communities of youth in which self-injury is encouraged and viewed as normal and exciting, which could potentially increase the  risk for self-injury. The study warns that health professionals need to be aware of this type and source of content, and to inquire about it when working with youth who practice self-injury because sites like YouTube can reach youth who may not openly discuss their  behavior. Self-harming is not typical behavior for otherwise untroubled teens and young adults, explained Dr. Charles Raison, an Emory University psychiatrist and CNNHealth.com's mental health expert. It’s an action that kids with psychiatric problems may try. “NSSI is a young person’s affliction…one in ten will kill themselves," he said.   "A lot of people will outgrow the behavior.” Raison said that it’s common for troubled young people to share information about hurting themselves. Treatments can include antidepressants, antipsychotic drugs and psychotherapy.

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