Daily Dose

Stop Bullying Now!

1.30 to read

October is National Bullying Prevention Month.  This is one topic that should be discussed with our children, and not only during the month of October.

Bullying is defined by an American Academy of Pediatrics (AAP) policy statement  as “a form of aggression in which one or more children repeatedly and intentionally intimidate, harass, or physically harm a victim who is perceived as unable to defend himself or herself”.  

Unfortunately, study after study shows that the incidence of bullying is on the rise with the most prevalent bullying occurring during the middle school years.  One study I read stated that “160,000 students skip school everyday to avoid being bullied”.  Another study stated that somewhere between 10-40% of middle school students report being bullied. 

Where does bullying begin?  Sadly, some of the bully behavior is modeled from parent to child, and parents can be part of the problem.  Good behavior and acceptance of others needs to begin in the home with parents discussing hurt feelings and mean language in the toddler years. How many times have you heard yourself saying to your own child, “when you say that it hurts my feelings”, or “did that person hurt your feelings?”  These lessons are taught early on, beginning in the sandbox. The discussions really continue throughout childhood but are obviously age appropriate.

When talking to my patients during middle school years about bullying and the “mean girls”  phenomena (verbal and cyber bullying is more common among girls, while physical bullying is more common among boys) I ask about their friendships and how they perceive themselves as friends. Many middle school patients of mine report feeling excluded from some groups, or events, but at the same time are learning how to decide who are their “real” friends. The discussion often comes back to the basic, “if you are nice to everyone, you will find that you are not very interesting to bully or gossip about”. Sounds easy, but it is really hard to always be nice. It is a good place to start.

Bullying not only causes emotional effects it is often linked to physical effects as well. Anxiety, depression, substance abuse, physical complaints  (head and tummy aches)  and even suicidal ideas may all arise due to bullying. These are all problems that I see in my own practice.  

Take some time to engage in a bit of dinner conversation and talk to your children about the various types of bullying and how to prevent it. 

Daily Dose

Teens Not Getting Enough Sleep

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If you're the parent of a teen, this does not surprise you at all:  teens do not get enough sleep!    

An online study released by the Center for Disease Control and Prevention says, “70 percent of high school students are not getting the recommended hours of sleep on school nights”.  I could have done that study in my office on any given day of the week! 

Having raised 3 teenagers as well as thousands of teens in my practice, I know this to be true, first hand. The problem is this age group is least likely to believe or convince that lack of sleep causes a plethora of physical as well as psychological problems. 

According to the CDC study, which was just published online in Preventive Medicine, insufficient sleep is associated with numerous “risky” behaviors including drinking alcohol, smoking cigarettes, fighting, lack of physical activity and being sexually active.  The data on sleep was accumulated from the 2007 National Youth Risk Behavior Survey where students were asked, “on an average school night, how many hours of sleep do you get?” Insufficient sleep was defined as less than 8 hours, while sufficient sleep was 8 or more hours per night. On an average school night, almost 70% of responders reported insufficient sleep.  

In my practice I ask every child/adolescent about their sleep habits and routinely find teens are averaging between 5–7 hours of sleep per night. They also come in everyday with a chief complaint of FATIGUE! 

I used to tell my own sons throughout their high school years that they needed to be in bed at 10:30p.m.  They could not understand why I was up “prowling around their rooms” in the dark of night demanding, that they go to bed. “No one else has a bedtime in high school” was the common complaint.  

But I also told them that I made my living out of telling teens (and their parents) that the reason their child “felt badly” was not mono, or a dreaded disease, but lack of sleep.  

Those teens who did not have adequate sleep also drank more soft drinks (did not include diet), used computers for 3 or more hours every day, admitted to current alcohol, cigarette and marijuana use, were sexually active, and also expressed more feelings of being sad or hopeless or even of having suicidal thoughts. 

If we could improve these statistics and reduce so many teenage “health risk behaviors” by just having parents enforce bedtimes, it sure seems like an easy sell. 

Set a time, turn off the electronics and “put your teen to bed”. I know they have homework and tests and papers to write, but they also must be healthy, and rested to make good choices in both school and outside the home. 

Oh, the study also found that watching 3 or more hours of television each day was not related to insufficient sleep. You might leave that part out!  

Daily Dose

Good Grades Pill

1.15 to read

There is a lot of pressure placed on students to succeed and many of them are turning to what teens call the “good grade pill”.  What is it?  Prescription stimulants that are commonly used to treat children with ADHD.  Teens that have not been diagnosed with ADHD have figured out that with the help of these drugs, they can focus and improve their grades.  

I see a lot of kids who have attentional issues and I evaluate and treat children for ADHD. With that being said, I also spend a great deal of time with each family looking at their child’s history, report cards, teacher comments, educational testing and subjective ADHD rating scales. 

While many families would like it if I just “wrote a script for a stimulant”, I feel it is my job to try and determine to the best of my ability, which children really fit the diagnosis of ADHD. (There are specific criteria for diagnosing ADHD). 

But in the last 3-5 years I personally have seen more and more teenage patients coming to me with complaints of “having ADHD”. These are successful teens who are now in competitive schools. 

In most of the cases there have never been any previous complaints of difficulty with focusing or inattentiveness. All are typically A and B students but are now having to work harder to keep their grades up, and to also keep up all of their extracurricular activities. They too all want to go to “great colleges” and their parents expect that of them as well. 

When I see these teens, I point out to them that there has never been mention of school difficulties throughout their elementary and middle school years. I also tell them that ADHD symptoms by definition are typically evident by the time a child is 7 years of age, and often earlier.  So what do you do? I don’t take out the script pad. 

I believe that stimulant medications are useful when used appropriately.  I am also well aware that these drugs are overprescribed and are also being abused. I have had parents (and teens) be quite upset with me when I decline to write a script for stimulant medication for their teen.  

I think that this problem is growing and (we) parents need to stop pressuring our children and (we) doctors need to be vigilant in deciding when stimulant medications are appropriate. 

It is a slippery slope, but the number of teens obtaining stimulants illegally is on the rise.  Why? They hear that this is a quick fix to getting good grades. It may help their grades for the short term, but what does their long term future look like? 

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

Daily Dose

Your Baby's Cough

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If you’re the parent of a 5-10 month old baby, have you noticed that your baby is coughing, but they don’t seem to be sick?  Does the cough clear your child’s congestion or their throat which is what pediatricians like to call an “effective cough”?  I bet you want to know why your baby only coughs when you’re around.  I have always said parenting starts at a very young age and this is one of the first signs that your child is learning to “manipulate” you a bit…truth! 

This back and forth with you and our baby is called an “attention cough” and occurs when your baby realizes that when they cough you turn your head to look at them. Now, you are probably only turning your head to make sure they are ok, but your baby just sees your face turn to them and that you make good eye contact which is  reward enough for a cough!  Very clever! 

An attention cough is one of the earliest ways that your baby gains your attention.  Later on it may be high-pitched squeals, followed by them throwing a toy your way.  All of these are just a means of early “nonverbal” attention seeking behavior. Just wait, I promise it will continue and it may not always be quite so cute (think teenage years).

 So, if your child gets a little cough, it doesn’t seem like they are sick and you find yourself turning your head, the diagnosis may be “attentional cough”. Save yourself a trip to the doctor and a co-pay as well.  The best thing to do is just smile.

Daily Dose

Witnessing Traumatic Events

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Unfortunately, you are aware the tragic event which occurred yesterday in Newtown Connecticut where a gunman opened fire in an elementary school. There are numerous tragic and traumatic events which occur across our country (and around the world) and at times, children may be witnesses to these events.  With that being said, how do you discuss these tragedies with a child? I think the most important thing to remember when talking to a child about a trauma or tragedy is to use words that are appropriate for the child’s age and vocabulary and to acknowledge your own feelings as well. They need to know that you too were scared, sad, upset or anxious about the event. Ask them how they felt and listen to the words that they use as you may use those words again when talking to your child. While every child is different you can often follow their cues as to how much and how detailed a discussion to have, and when and how to bring the topic up again. Some children are talkers and want to discuss things at length, while others may be quieter and take some time to absorb the information. Don’t force the discussion.  A parent knows their children and the discussion may/will be different for each child and will be further impacted by their ages. For young children, it is also important to let them know that “Mommy and Daddy” are there and will take care of them and protect them, but at the same time bad things sometimes happen. That is why parents take precautions and are responsible (like holding hands when crossing the street, or wearing a helmet etc).But, if something does happen it is so important to validate your child’s feelings while at the same time teaching your child coping skills and resilience. If your child does view a traumatic event it is not unusual for them go through a period when they are afraid of separation, or have nightmares etc. They sometimes develop somatic complaints like tummy aches, headaches, and non specific complaints of “I just don’t feel well”. This is normal, but you should watch for a child who seems to “be stuck” with symptoms long after the event. In some cases a professional therapist may be helpful. Lastly, don’t let them revisit the event. By that I mean keep the TV off for awhile, and monitor the internet so they are not watching constant images of the same event (like the falling of the twin towers on 9/11). With so many amateur videos of traumatic events being shown “on screen” 24/7 if your child sees these images over and over, it is as if they are reliving the experience each time.  It sometimes may feel as if we become addicted to watching it.  It was nice “in the olden days” when there were not constant images on screen to remind us of a picture that often fades in our own minds. Our prayers go out to all the families grieving at this time.

Daily Dose

The Reality of Teen Suicide

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I have been saddened by the recent suicide of a young man in our community. It is still hard for me to fathom that parents I know have suffered through the loss of their child from suicide.  There are really no words for the shock and grief that is felt on so many levels.

Unfortunately, teen suicide is not as uncommon as you might think. Each year, there are thousands of teens that commit suicide. Suicides are the 3rd leading cause of death for 15–24 year olds. In 2000, the CDC reported 1 out of 12 teens attempts suicide and up to 1 in 5 teens state that they have contemplated suicide at some point during their adolescent years. The statistics also show that the incidence of teen suicide has been increasing over the last years, which seems to correlate with the mounting pressures, both real and perceived, that our youth feel. As an adult I think "what could be that terrible to drive a teen to end their life when so much lies ahead of them?”.  But a teen’s brain is not fully developed, and as any parent with a teen knows, teenagers are often impulsive with little thought of the true consequences of their actions.

Teen suicides are usually related to depression, anxiety, confusion and the feeling that life is not worth living. An event such as a break up with a girlfriend or boyfriend, substance abuse, or failure at school may lead to suicide.

There are also gender differences among teens who commit suicide.  Teen girls are more likely to attempt suicide than teen boys. With that being said, teen boys are more likely to complete a suicide.  Girls are more likely to use an overdose of drugs to attempt suicide while boys are more likely to shoot themselves.  While a girl may use an overdose or cutting  as a “call for help”, there is often little opportunity for  intervention with a male who sustains a self inflicted gun shot or may even hang themselves.  Male suicide attempts are typically more violent and are 4 times more likely to be successful.

There are several things that parents, teachers and friends should be aware of as “warning signs” for adolescent depression and the possibility of suicide. A teen who suddenly becomes isolated, changes friends, has a change in their school attendance or grades,  has a substance abuse problem, is being bullied  or begins to make statements in reference to ending their life,  should be taken seriously. Professional help is absolutely necessary when dealing with these issues and parents should not attempt to “solve the teens problems” on their own.   

There are numerous resources available and the suicide prevention hotline at 1-800-SUICIDE is a 24 hour service. Lastly, over half of teen suicide deaths are inflicted by guns.   Firearms should not be kept in a home unless they are locked, and the key should always be in the care of a parent.  It might also be prudent not to have ammunition in the house if you do have a gun. If an impulsive, depressed teen has to go buy ammunition before attempting suicide they might be more likely have an epiphany and realize that things are not as hopeless as they think.  Any deterrent may be all that is necessary to prevent a suicide and the ensuing heartbreak for all those that knew them.

Send your question or comment to Dr. Sue.

Daily Dose

Diagnosing Appendicitis

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I received a phone call the other night from a college-aged patient who was in the middle of finals but she was also complaining of abdominal pain.  She gave a great description of having had generalized abdominal pain earlier in the day and had tried to ignore it as she was studying, but over the course of about 8-10 hours the pain had gotten worse and was beginning to be more pronounced in her right lower quadrant. She was nauseated but had not vomited, and was not sure if she had a fever but felt warm.  There were enough clues in her history to interrupt her studying (“are you serious?”) and send her to the local ER in her college town for an evaluation.  

Guessing that she had appendicitis, I talked to the ER doctor and it was decided to ultrasound her for suspected appendicitis. Unfortunately, they could not get a good look at her appendix and the diagnosis was not confirmed. 

The next radiographic test that is usually ordered when trying to diagnosis an inflamed appendix is a CT scan.  Unfortunately CT scans require radiation exposure (unlike an ultrasound) and there is continued concern about cumulative radiation exposure, especially among young patients. I had just read an article published this spring in the New England Journal of Medicine. The article discussed the use of low dose CT vs. standard dose CT for diagnosing appendicitis. 

The article showed that the low dose CT was not inferior to standard dose CT (if performed on non-obese patients) for diagnosing acute appendicitis. So, this young lady underwent a low dose CT scan which indeed confirmed her “hot appendix”.  She was scheduled for surgery early the next am (by now it was almost dawn) and had her appendix removed laparoscopically. She was ready for discharge the following day! 

Bottom line:  less radiation, timely diagnosis, still able to wear a bikini as procedure used a scope vs. open incision and she was back at school in 2 days and finished her finals!!  The wonders of modern medicine. 

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

Daily Dose

Stranger Danger

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We had a question via our iPhone App from an aunt who wanted to talk to her twin 4 year old nephews about “stranger danger”. Unfortunately, this topic has been in the news quite frequently lately with child abduction cases being reported all around the country. The National Center for Missing and Exploited Children has numerous resources for educating children about safety.  Interestingly, most perpetrators are not actually strangers, but are often someone the parents or another adult knows and may have been around the child on occasion. So, it seems that “stranger danger” may not be the appropriate term to use when teaching our children, especially younger, children about safety. It is important that the conversation about safety begins with children at young ages. It is often easier to use teachable moments to begin the conversation with young children.  Talk to your child about “safe” strangers, as it is hard for a child to understand why you are talking to grocery store clerks, or people on the playground in the park, and yet they are strangers. It may be best to teach a child to watch out for dangerous behaviors from adults, rather than saying “never talk to strangers”.  Talk about adults who might approach them for directions, or to find a missing pet and role play as to what they should  do. At the same time, teach them that they can turn to “strangers” such a store clerks or mothers with children for help if they are scared. While talking about this subject use a calm reassuring manner.  You do not want to make your child “too” anxious as most people they will meet are not dangerous, and children do need to interact and trust numerous people around them that they will meet in  different situations. Another good way to discuss the issue of “stranger danger” is by reading books to young children that deal with the issue. Several good books that I like are:  The Berenstein Bears Learn About Strangers; A Stranger in the Park; I  Can Play it Safe.  There are many other books out there too, so head to your library  or your local bookstore to get some more recommendations. The librarians are often helpful with finding “age appropriate” books.  Lastly, this is not a one time conversation, but should be discussed at different ages and stages of your child’s That's your daily dose.  We'll chat again tomorrow.

Daily Dose

More Teens Testing Positive for STD

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I was thumbing through one of my many journals and came upon a recent study which had some surprising data regarding teens, sex and STDs. This study was from Emory University released in the journal Pediatrics. The researchers looked at the rates of 3 sexually transmitted infections which can be detected in urine, and found that more than 10% of teens who had said they were abstinent tested positive for a sexually transmitted disease. This is the second study, the first being released in 2005, which also showed that there were not significant differences in STD rates between teens who had pledged to be virgins until marriage and those who had not. In other words either teens are not being truthful about their sexual history (are you shocked?) or they had “forgotten” that they had had intercourse in the last 12 months. In either case the results of this latest study might indicate the need to perform routine urine STD screening tests on all teens, rather than only those teens who admit to having sexual activity. In the latest study, 14,000 youth agreed to provide a urine specimen to check for 3 common STDs:  Chlamydia, gonorrhea and trichomniasis.  More than 11,000 of the teens in the study said that they had had sexual intercourse in the last 12 months, while 3,000 teens reported no sexual intercourse during that time. Of these urine samples, there were 964 that tested positive for a STD, 118 of these were from teens who denied having intercourse in the last 12 months, and 60 of those said they had never had sexual intercourse in their lives.  Really?? This was quite an interesting study to me as I routinely ask my teenage patients about sexual activity, and while I think many of my patients are honest with me (as I tell them it is important to be honest so that I may treat them appropriately). I am also not naïve enough to think that they are all completely open and truthful. In this study 10% of those found to have an STD claimed to have been abstinent for 12 months and 6% claimed that they had never had penile/vaginal contact. Maybe there is a question of semantics?   It may be that we need to have even more specific questioning surrounding the “definition of abstinent”.  I often have teens ask me about a specific incident that they were involved in and they say “Does that count as sexual activity?”  This study speaks to that issue, differ people have different definitions of abstinence. The most important message from this study is that we doctors may need to be testing all teens for STDs on routine urine specimens.  The sexually transmitted diseases in this study need to be treated with appropriate antibiotics, not only in the patient but also their partners. As both a doctor and a parent, I know that the reality is that teens, for many different reasons, are not always truthful.  A simple urine specimen may be the best way to make sure that we don’t miss potentially serious infections. That’s your daily dose for today.  We’ll chat again tomorrow. Your thoughts? Let me know! I would love to hear from you.

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