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Daily Dose

Sleep

1:30 to read

Bedtime routines are very important!  Many kids are getting up earlier and earlier for some sort of practice (often before the sun comes up) so going to bed on time makes everyone in the house wake up in a better frame of mind and mood for the day ahead.   

 

Bed time battles are typical for a toddler who has learned to ask for “one more book”, or for the elementary school child who swears “they are not tired” but who falls asleep during bath time.  But who knew there would be even more battles with teens and their electronics??

 

Numerous studies have shown that electronics disrupt sleep.  But, trying to convince your adolescent son or daughter that they need more sleep is a daily struggle. While the studies on sleep recommend that teens get between 8 to 9 hours of sleep, most teens are not even close to that!  (90% report less than 9 hours).

 

During the summer teens keep all sorts of crazy hours and many get the majority of their sleep during what we would consider to be “daytime” hours…as they go to bed at 2 or 3 am and sleep past noon.  So, the minute that school resumes after summer vacation they already have sleep issues trying to “re-adjust” their biological clocks…and then you throw in the use of electronics right before bed and you have the perfect storm for sleep deprivation and daytime fatigue.

 

The American Academy of Sleep Medicine found that “adequate sleep duration on a regular basis leads to improved attention, behavior, learning, memory, emotional regulation, quality of life and mental and physical health”.  There isn’t a parent around who doesn’t want happy, rested, studious and healthy kids…of all ages. If you throw in less moodiness for teens who get more sleep most parents would sign their teens up on the spot.

 

Why do we all need to disconnect from electronics in order to have better sleep?  That blue light from the electronic screen…of any shape for or fashion works against sleep. It signals the brain to suppress melatonin secretion, which is the hormone that makes us get sleepy at the end of the day. The light from the screen also confuses the brain of it being daytime and increases alertness which may delay sleep…even after turning off the screen.

 

Try this new family rule, parents included, that all screens (phones, tablets, computers) will be off and docked outside of the bedroom at least 30-60 minutes prior to bedtime. While your teen may insist that they won’t use the phone, it is often too tempting to not “cheat” once you are in your own room and asleep. 

 

While this may initially be hard to enforce, once it is the family routine it becomes less of a battle. Everyone will have an easier time falling asleep and staying asleep, and maybe get a few more hours of “shut eye”.    

 

 

Daily Dose

Bullying

1:30 to read

The incidence of bullying continues to rise even 1 month into the school year. While excitement and a bit of anxiety are typical emotions for children as they find out their new classes and teachers, there are a group of students who have tremendous anxiety about going back to school….those children who have been victims of bullying.

 

It depends which study you read but somewhere between 10-29% of students report having been bullied. This represents around 13 million kids.  Some studies also show that somewhere around 6-10% of school aged children may be chronic victims of bullying.  No matter the number or statistic, bullying is an ongoing problem among school aged children and may have long last effects on both the child who has bullied as well as for the child who was bullied. 

 

Bullying by definition is “unwanted aggressive behavior among school aged children that involves either a real or perceived power imbalance”. Bullying behaviors are also typically repetitive. Boys are more likely to be bullies and may bully boys or girls while girls tend to bully other girls more often. 

 

There are different types of bullying. It may be physical (not as common), verbal, exclusionary, or cyberbullying.  All of these types of bully behaviors cause psychological and/or physical distress for the victims.  Victims of bullying are more likely to miss school and will have absences for “unknown” reasons where they may just report “not feeling well”.  These children  may often have frequent headaches and stomach aches without any physical findings.  I find that in many cases of bullying a child has been “well all summer” and the physical distress returns once school resumes. Victims of bullying also report difficulty in school with focus and concentration as well as depression and isolation.

 

The majority of bullying takes place at school, especially at times when there may be less supervision by teachers…during recess, lunch time,  bathroom breaks, and on playgrounds.  Unfortunately with the advent of cyberbullying and the use of cell phones, tablets and computers to send mean texts or emails more and more bullying may be occurring outside of school. 

 

Just as teachers need to be aware of bullying at school, parents need to know what their children are doing online. Now is another good time to discuss or re-visit the issue of online bullying and review your own family rules for posting or texting, reminding your child that anything they post may be seen by anyone. Don’t post or send anything to anyone that could hurt or embarrass themselves or others. It just takes one person forwarding a message for it to become “viral” and it will remain in that “mysterious cloud” forever!

 

Prevention of bullying requires that students, teachers, administrators and parents all work together.  Encourage your child to report any bullying behavior or concerns that they have and to get the school year off to a good start. 

 

One last statistic: parents who are involved with their children (including their online lives) and have clear and concise rules are less likely to have children who are either those who bully or are victims of bullying.  

 

  

Daily Dose

Lice is Tough to Treat

1:15 to read

What are kids bringing home from school besides their homework? Lice! The good news is: lice are obligate parasites and don’t jump, or fly…they are transmitted by direct contact.  But, the smart louse has found another way to drive parents crazy…they are becoming more and more resistant to all of the over the counter products containing permethrin. 

A recent study has shown that 25 states now have a big problem with lice and permethrin resistance.  It seems that the lice are smart and they have developed “genetic mutations” which has made them drug resistant. Texas has had a problem for several years and I have had many patients coming into the office with bags full of “stuff” that they have used to treat their children’s head lice to no avail!!!  Many a mother has told me she is ready to try anything…including some things that might be considered unsafe, but you know a desperate mother.

While about 12 million children a year get head lice, the louse itself does not cause any disease, but just uncomfortable itching.  Parents spend multi millions of dollars each year trying to eradicate head lice. In states like Texas, California, Florida and Virginia the lice are immune to over the counter products, while in New York, New Jersey and several other states they are partially resistant. 

But don’t despair, despite the resistance to the over the counter products such as Nix, there are other prescription products available. Products such as benzoyl alcohol (Ulesfia), ivermectin (Sklice), malathion (Ovide), and spinosad (Natroba), may all be used to treat a case of head lice, but will require a prescription to obtain them.  Although prescription drugs typically are more expensive, treating head lice with an over the counter product may be an exercise in futility. It is likely to be more cost and time effective to start with a prescription product if you live in one of the 25 states which has shown drug resistance.

So, if you get a note that your child has head lice, pick up the phone and call your doctor’s office to see what advice they give you. 

Daily Dose

Over-scheduling Your Kids

1:30 to read

Are your kids busy with activites this weekend?  Is your child going to be over or under scheduled?  It is sometimes difficult to find a happy medium.

 

I am still a big believer in the “one sport” per season rule and one other activity..maybe two if the third activity does not require a weekend game or practice.  So, what does this look like for a child in elementary school….soccer, fall baseball or football for the fall season, as well as girl scouts, boy scouts, debate team, chess team, and then maybe piano or flute lessons?  You can change that up in anyway and substitute dance, gymnastics, volleyball, a foreign language class…but you get the picture. In this way your child should have several days a week with “NOTHING” to do after school…except go outside and play!  This gives the parent or caregiver a break as well from driving all around to transport to the venue for the practice or game.

 

I hear so many complaints from parents who are in a constant state of stress from trying to figure out transportation for their child to the soccer practice that conflicts with the football practice and the lacrosse practice. This also requires trying to  juggle the multiple games on the weekend that go on for hours one after the next, and even on Sunday mornings.  When I hear the parents complain about this ridiculous schedule I am also seeing the children who are over tired, burnt out and may even have stomach aches and headaches due to the stress of being over scheduled.

 

While every parent is well intended and wanting their child to have as many opportunities as possible in both athletic and other extracurricular activities, a parent also needs to sometimes say “no”.  Discussing the logistics as well as the time commitment for each activity, in an age appropriate manner, may help a family decide which activity stays and which one is “punted”.

 

So….sit down before you and your child are overwhelmed and pick the activities that you will do this fall…but leave some room for being bored. Boredom is a noun that we need to hear more often.

 

Daily Dose

Diagnosing Stomach Aches

I see a lot of children in my practice with recurrent abdominal pain, and the end of the school year is especially note worthy for causing "stomach aches". It always takes a little more time to get a good history from the child and parent about the tummy aches. You need to ask where the pain is located, how does it feel (burning, stabbing, crampy?), what things seem to make the pain worse, what makes the pain better, is it worse in the morning or evening, does the pain awaken the child from deep sleep (very important and different than does it keep them from falling asleep).

I always try to get a good stool history, which is the most daunting problem, as kids don't like to discuss their poop! You also need to know if there has been fever, weight loss, recurrent vomiting, blood in stools, rash or other systemic symptoms. Lastly, how long has it been going on, days, weeks, months and does it cause them to miss school, play dates, after school activities etc. routinely. In the majority of cases after a thorough history many of these "tummy aches" are worse in the morning, do not wake them up from sleep, do not prevent the child from going to dance or soccer and if they stay home from school seem to be better before lunch, really have not changed their appetites except when the tummy hurts, and there has been no weight loss or other systemic symptoms. On physical exam the pain is usually right in the middle of the abdomen with no localizing areas (this is called peri-umbilical), and usually a good sign. Their abdomens will be soft and if you exam them while talking (to distract them) you get the sense that they are not tender, they do not have any masses, have good bowel sounds and there are no specific areas of pain. Many of these kids are diagnosed with functional abdominal pain (FAP), which is the ongoing presence of abdominal pain for which no physical explanation or findings can be found. A child with FAP often is challenging as the problem is benign, but the symptoms of recurrent stomachaches cause a lot of stress to the child. Education for the family and child is probably the most important part of their treatment. It is helpful to summarize the child's symptoms and exam and explain that although the pain is REAL, there is most likely not a serious underlying disease (like cancer, tumor, ulcer, appendix). The goal is to get the child to return to normal function rather than complete disappearance of their pain. In most cases the child is relieved by the findings and often the pain will diminish as their anxiety does too. Funny thing, I rarely seen recurrent stomach aches in the summer. That too is reassuring for both family and child. That's your daily dose, we'll chat again tomorrow.

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Your Child

Your Child’s First Day at School

1:45

While I may have forgotten a lot of things in my life, I remember my first day of school. I was so excited because I actually recognized someone. Her name was Donna. We’d met in a department store a week earlier. We had both picked out the same umbrella, but there was only one – she said I could have it. We’ve been friends for life.

When my daughter began school, she experienced all the same emotions I had those many years ago; scared, excited and uncertain where to go and what to do next. She found a friend also and they wandered the halls together.

Some school districts have already begun their new school year, but for many kids - the bell will ring in the next couple of weeks.

Children aren’t the only ones that are anxious as the first day rolls around – parents can get quite nervous and have that feeling that their little one is growing up so fast- trust me I know. It’s a normal “things are about to change” emotion.

One tip I’d like to suggest before your little one starts school is to share your own first day memories with your child as well as pictures. It’s amazing how comforting it is for a child to know that their parents did the same thing at their age and lived to tell about it!

To help make the first day of school a little less scary for your child, here are some other tips from https://www.healthychildren.org:

•       Point out the positive aspects of starting school: It will be fun. She will see old friends. She will meet new friends. Refresh her memory about previous years, when she may have returned home after the first day with high spirits because she had a good time.

•       Remind your child that he is not the only student who is a bit uneasy about the first day of school. Teachers know that students are anxious and will be making an extra effort to make sure everyone feels as comfortable as possible.

•       Talk about the kinds of interesting things he will learn in the months ahead.

•       Buy him or her something (perhaps a pen or pencil) that will remind her you are thinking of them while they are at school, or put a note in their lunch-box.

•       Reassure your child that if any problems arise at school, you will help re­solve them. (If problems do occur, get involved as soon as possible.)

•       Find another child in the neighborhood with whom your youngster can walk to school or ride with on the bus. If your child is not going to ride a school bus and you feel it is appropriate, drive your child (or walk with her) to school and pick her up the first day.

•       Encourage him to look for new students in his classroom or in the play­ground, invite them to join the group for a game, and ask them about their interests.

•       After school, show your child some special attention and affection. Give him or her a hug and ask what happened at school. Did she have fun? Did he make any new friends? Does she need any additional school supplies (notebooks, rulers, erasers) that you can shop for together?

In addition to the suggestions listed above, your child may need some extra support if he or she is starting school in a new location. Here are some suggestions to make the transition easier.

•       Talk with your child about his or her feelings, both their excitement and their con­cerns, about the new school.

•       Visit the school with your child in advance of the first day. Teachers and staff are usually at school a few days before the children start. Peek into your child's classroom, and if possible, meet the teacher and principal. You might be able to address some of your child's concerns at that time. She may have no questions until she actually sees the building and can vi­sualize what it will be like. (When you formally register your child in the new school, bring her immunization record and birth certificate; usually school records can be sent directly from school to school once you sign a "release of information" form.)

•       Try to have your child meet a classmate before the first day so they can get acquainted and play together, and so your child will have a friendly face to look for when school begins.

•       Do not build up unrealistic expectations about how wonderful the new school will be, but convey a general sense of optimism about how things will go for your child at the new school. Remind him that teachers and other students will be making an extra effort to make him feel welcome.

•       If your child sees another student or a group engaged in an activity she is interested in, encourage her to ask if she can participate.

•       As soon as you can, find out what activities are available for your child in addition to those that occur during school itself. Is there a back-to-school picnic or party planned? Can he or she join a soccer team? (For community sports programs, sign-ups often begin weeks or even months before the start of the season.)

It’s been many years since my first day at school but I remember it well. Your child’s life is about to change forever, but that’s a good thing-another milestone in life’s progression. Give him or her a hug, wipe away the tears and smile a big smile. Let them know you trust them and are proud of them. Then go ahead and shed a few tears of your own when you’re back in the car. Yes, they are growing up fast. 

Story source: https://www.healthychildren.org/English/ages-stages/gradeschool/school/Pages/Making-the-First-Day-of-School-Easier.aspx

 

Daily Dose

How To Soothe Back-To-School Jitters

1.45 to read

It is not uncommon for children to be both excited as well as apprehensive about the start to a new school year.Where has the summer gone?  Do you feel like I do and think, I blinked and POW it's back to school!  There's a lot of excitement for the new school year but some are feeling a bit nervous and anxious.

It is common for children to be both excited as well as apprehensive about the start to a new school year. Being a little worried about heading back to school is normal. Whether your child is going to the same school, but concerned about their new teacher, or starting a new school, the underlying uncertainty is normal. I can remember lying in bed the night before the first day of school and being so excited that I couldn’t sleep. I was always most excited about what “new outfit” I was going to wear. My mother had of course taken me shopping weeks before for the “back-to-school” skirt and sweater, and I just couldn’t wait to get to wear my new clothes. Back-to-school jitters are normal and should be discussed several days before school begins. It is very common for a child to have anxiety and stress related to a new school. But it is also not uncommon for children to worry about little changes related to such things as new lockers, cafeteria changes, a new teacher, or new friends. Some children will complain of tummy aches and headaches with the beginning of school. I am always reminded that I rarely hear children complain of a headache or tummy ache during summer vacations. These “aches and pains” are often a manifestation of a little underlying anxiety, and seem to be a September – June phenomena. A little parental reassurance will often help relieve those aches. The best plan for dealing with back-to-school jitters is to acknowledge the anxiety and plan on how to deal with it. Make sure that your child is rested for the first day of school and they have a good breakfast to start off the day. On the way to school discuss all of the positives for the new school year. Make your goodbyes short and sweet. Let your child know you will be there at the end of the day. Do not let your child see you upset, as sometimes parents too are anxious about the first days of kindergarten, high school or even college. Those back to school pictures are memorable and you will always like looking at the pictures with everyone smiling, even if your parental heart is a little sad at letting go. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

School & Infectious Disease

1:30 to read

I received an email this week from a patient…subject line: “potential exposure to Herpangina”.  In the body of the email was the following:

Dear Parents,

We want  to inform you that a case of Herpangina disease has been reported for a child at ….. room #112.  This is a contagious disease that  is spread by direct contact with another person or contaminated objects.  Herpangina is an illness caused by a virus, characterized by small blister-like bumps or ulcers that appear in the mouth, usually in the back of throat or the roof of the mouth. The child often has a high fever with the illness. We have attached further information about this common childhood illness published by Children’s Hospital in Boston. Our teachers are carefully disinfecting their room to help prevent further spread of the disease.

The mother of the child that sent me the email was “freaked” out and “worried” about  sending her child back to pre-school.  

My question is this, when did it become a “rule” to notify parents in a pre-school or day care setting that there were viral illnesses circulating?  It certainly seems unnecessary to me to send notification of EVERY childhood illness that occurs and for most of my families only serves to cause anxiety.  Some of the schools in our area post a sign on the entry that says something to the effect:  “there are cases of diarrhea, RSV, hand foot and mouth and fevers being reported in children that attend this school.”  Really, is it that surprising or necessary? Seeing that many of the numerous viral illnesses that children get these days are spread via respiratory droplets and contact with surfaces, such as toys and tables that everyone touches (computers too), children are exposed to things all of the time.  Do you go to work and ask your co-workers in a conference room..have you had diarrhea, a cough or a sore throat in the last day?

I understand notifying parents of illnesses, such as meningitis, measles, mumps…even chickenpox that are infectious and may be serious or life threatening. Thankfully, there are very few cases of these illnesses to report, now that the MAJORITY of children receive vaccines to these diseases. 

By putting these emails, texts and notices out for every parent to become alarmed about…and then to come to the doctor out of concern that their child  “may get sick….even before they have a symptom”,  serves no purpose. Herpangina and Hand Foot and Mouth are very similar viral illnesses, and both are caused by enteroviruses. It is at times hard to distinguish one illness from the other. But, with that being said, the treatment is solely symptomatic. In other words, treat the fever, make your child comfortable and don’t let them go back to school until they are fever free for 24 hours.  

Lastly, your child is going to catch a lot of these viruses, no matter what you do when they go out to play, shop or go to school. Each time they catch a viral illness it actually helps them to build antibody in order that their immune system may get stronger and stronger. I think the better note is….as winter comes children will get more coughs, colds and viral infections…if you think you child is not feeling well or running a fever, please keep them home from school for the day.  It is just a normal part of childhood…we don’t need any more anxiety in this world.   

 

Daily Dose

National Walk to School Day

This day and the entire month of October is meant to bring awareness back to the need for children to walk to school when possible.Today is ‘National Walk to School Day' and as a seven year old so aptly stated, "this was fun and good for my mom's health too." It seems that it has become uncommon these days for children to walk to school, although it was something that used to be one of the best parts of the day. This day and the entire month of October is meant to bring awareness back to the need for children to walk to school when possible. There are many reasons to encourage this, as a form of exercise to promote childhood obesity, to save on gas during skyrocketing gas prices, and to promote environmental consciousness.

It is a privilege to live close to a school and have leisurely walks where you can talk about the day ahead, kick a rock or pick up the first leaves of fall. But we need to change community cultures to promote safe routes to walk to school and to promote neighborhood children and parents to walk together. This same idea needs to be encouraged for those children who might want to ride their bikes to school, of course with a helmet, and get their parents to ride along. It also teaches the rules of the road and safety for crossing streets and intersections. So....pick a few days this fall to opt out of carpool, get the dog and a cup of coffee and walk to school with your child. It is guaranteed to create lots of conversation and most likely fond memories of your childhood walks to school. That's your daily dose, we'll chat tomorrow. More Information: International Walk to School Day in the U.S.A.

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