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Daily Dose

Sleep

1:30 to read

Back to school bedtime routines are very important!  Now that kids are having to get up, (often before the sun comes up) 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.

 

Start the school year with the 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

Schools around the country are opening their doors as a new school year begins. 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

Toddlers & Tantrums

1.15 to read

I see toddlers for check ups nearly every day and for both the 15 month and 18 month visit, there are many challenges for parents and the pediatrician (and of course the child). Toddlers are not at what I would call an EASY age.

As you know if you have a toddler, they are quite moody (just wait for teenagers) and they can “stop, drop and roll” into a tantrum in the blink of an eye.  So while I was examining an 18 month old this week ( she is one of three adorable girls), she suddenly became infuriated (her mother and I were really clueless as to what triggered this) and she jumped off of her mother’s lap and fell to the floor kicking and screaming. 

Now, for a first time parent this might be alarming behavior, but for a seasoned mother of three it was really no big deal. Appropriately, we all just ignored her as she laid on the floor and screamed (no, the mother was not worried about germs on the floor either) and we continued our conversation about her child’s less than stellar sleep habits.

After a few minutes her daughter calmed down, the older sisters got her a sticker and she left without a fuss. Her mother had already learned, like we all do, that the best way to stop tantrums is by ignoring them and letting your toddler have some time to “express her emotions” with age appropriate (although inappropriate for older children) behavior.  

Several days later, her mother sent me an email with another picture attached of the same child having yet another tantrum after she found her in her diaper with a sharpie pen happily marking all over herself (the photo above). Of course, the minute she took the marker away her daughter fell to the floor again to express her outrage! So funny that her mom thought to document it and send me another picture.

By the way, she also told me that she had taken practical advice and was working on having her daughter cry herself to sleep and it was working well!  Both the tantrums and sleep were improving by just ignoring her behavior. Back to those laws of natural consequences.  

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Daily Dose

Teaching Your Kids About Their Private Parts

Why do parents give their child's private parts nicknames instead of real names? If you have a child who is over the age of 15 months I know that you have played the game  "where’s your nose, where’s your eyes, where’s your ears?” It is a favorite for both parent and child as a toddler learns to point to various body parts. This game is also an important milestone in observing a child process language (receptive speech) and follow a command.  But, what happens after your child has learned the usual body parts?   In other words, what about the rest of their anatomy, specifically their “private parts”.

This topic came to mind the other day while I was seeing a little girl who was complaining of burning and itching with urination.  This is not an uncommon problem in the 3-6 year old little girl set, and part of the physical exam involves looking at the child’s “private parts”. As I begin talking to both the parent and child I always start off with the statement, “I am going to look at your vagina, and it will not hurt”. I also say “no one else should pull your underpants down and touch your vagina. The only people that can touch your vagina are you, your mother or father, and the doctor. These are your private parts, they are covered by your underwear and never let a stranger or even a friend pull down your underpants”. It is important that this age child understand who may or may not pull down their underpants. But, with that being said, it is always amazing to me how many parents say, “we don’t call it a vagina or penis”, and on this occasion the mother said, “Dr. Sue means your bunny hopper!!”  Okay, really? What in the world is a “bunny hopper?”  Why would a parent not name the body parts correctly and where do these names for vagina and penis find their derivation? Over the years I should have kept a list of “secret names” for vagina and penis as I have heard many. From the “princess patch” to “peanut” to “bo-hiney” you name it, there seem to be many parents who either are uncomfortable, or just cannot bring themselves to use the correct word for genitalia. Even Oprah has her word, “va-j-jay”. I submit that we go back to the correct anatomical name. It is so important to teach your children the appropriate words for penis and vagina. Just as they learn eyes, ear, nose, knee, foot, toe they need to know the names of their “private parts”. If you begin with the correct words it never seems awkward or uncomfortable and is no different than naming any other body part. You will be surprised at how easily your child accepts these words, but uses them appropriately too.  It is also important to name body parts correctly, especially if there is ever a question of inappropriate touching or abuse, in order that a child can correctly explain what happened. I still have to laugh when I hear all of the different names a child hears when a parent discusses genitalia, it must be confusing.  But regardless of what you name it, a penis and a vagina are private parts and need to be covered by our underpants, keep repeating that message to your child. What do you think? Would love to hear from you!

Daily Dose

Over-scheduling Your kids

1:30 to read

Most schools in my area are starting in the next week or so….which also means after school activities are also getting ready to begin. 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

Toddlers: Tantrums, Time Out & Hoarding

Toddlers & tantrums go hand in hand. Here's how to make time out work for you!When I see my toddler patients, lots of words come to mind.  Busy, active, inquisitive, climbers, impulsive, biters, but never before did the word “hoarding” make me think of a toddler.

During an 18 month old well child visit the biggest discussion I have with parents is related to toddlers behaviors.  While a toddler may do the cutest thing one minute, the next minute they may be laying on the floor kicking and screaming and having a tantrum. Toddlers are truly like Dr. Jekyll and Mr. Hyde.  Parenting a toddler requires a great deal of energy, patience, and consistency.  While many people talk about “the terrible twos” I really think that one of the most difficult stages, as a parent, is from 15 months – 30 months. In other words a long time!! The reason I bring up hoarding stems from a remark from a parent during their child’s 18 month old check up. We had discussed so many topics related to their child and concerns that they had. We discussed how to ignore a tantrum and try to redirect the child after several minutes. We talked about how to begin time out.  I start using time out at around this age when a child has been overtly defiant (yes, it does happen to all of us).  In that case, when the behavior cannot be ignored, I use a small chair in the house and have a kitchen timer handy. I tell the child that they have “misbehaved by ----------------“ (fill in the blank) and that must sit in the time out chair for 1 minute. I typically recommend 1 minute per year of age.  If your toddler will not sit in the chair, then you go behind the chair and wrap your arms around the child (like a piece of human rope).  This way there is no eye contact, and you can restrain the child in the chair.  Of course, the child will be crying while this is going on as they are not happy about being held in a chair. Once the minute is over, go back around to the front of the chair, get down on your child’s level and explain again why they had to sit in time out. Over time (sometimes days, even months) your child will begin to understand that they sit in time our when they have misbehaved and they will learn to sit in the chair alone.  The concept of time out is useful throughout childhood, as you will see when you “send your teen to their room one day”, which is another variation on the same theme. So, at the end of this fairly lengthy visit the father says, “I have one more question Dr. Sue”. “Our toddler puts all of her stuffed animals in her crib. She plays with them and then just adds them to the crib so that by the end of the day the crib is covered with her stuffed animals and dolls.”  He paused for a minute and then said, “Is this a sign that she will be a hoarder?”   I thought I had heard it all but this was a new one!!  I started to laugh as I thought of those reality TV shows I had heard about with hoarders. I reassured the Dad that it is quite normal for a toddler to “hoard” all of their toys in one place. Their crib, or a favorite old cardboard box, or under the bed etc.  They like to “have control” over their toys, and this may be a way that their child “knows where her animals are”. I could not stop laughing the rest of the day as I thought about this. I just hope that the behavior modification discussions did not make him think he needed to “redirect” her toddler hoarding. This behavior sounds perfectly normal to me. I am still giggling about hoarding, very cute. That's your dialy dose for today.  We'll chat again tomorrow! Send your question to Dr. Sue!

Daily Dose

Breaking Bad Habits

1:15 to read

Do any of your children bite their nails or suck their thumbs? If so, are you always saying, “take your fingers out of your mouth, they are dirty”, or “if you keep biting your nails you will get sick due to all of those germs on your fingers”!  I was guilty of saying those very things to my own children, and I also remember being a nail biter and my mother saying the same thing to me.

Well, who would have thought that a study just released today in the journal Pediatrics might make us parents eat our own words (it wouldn’t be the first time).  The study, “Thumb-Sucking, Nail-Biting and Atopic Sensitization, Asthma and Hay Fever” suggests that “childhood exposure to microbial organisms reduces the risk of developing allergies”.  Who knew that there might be something so positive coming from a “bad habit”.  

This study was done in New Zealand and followed over 1,000 children born between 1972-1973 (dark ages) whose parents reported that they either bit their nails or sucked their thumbs at 5,7,9 and 11 years old. The participants were then checked at ages 13 and again at 32 years old to look for an allergic reaction ( by skin prick testing) against at least one common allergen.  And guess what…at 13 years of age the prevalence of an allergic reaction was lower among those children who HAD sucked their thumbs or bitten their nails.  Incredibly the the findings persisted almost 20 years later!  This study even looked at cofounding factors including sex, parental history of allergies, pet ownership, breast feeding and parental smoking… none of which played a role. 

So, while not advocating for children to suck their thumbs or bite their nails (which unfortunately I did until high school when I decided to have nails to polish) there may be a silver lining….a protective effect against allergies that persists into adulthood. 

Lemonade out of lemons!!!

Daily Dose

Teach Your Kids Good Manners

1.15 to read

Spring is always a busy time of year with end of school parties, proms, graduations, and lots of invitations.  These invitations are often sent not only to parents but many times they are sent to the kids as well. Some invitations have a reply card or say “please reply” or RSVP.   

Do your kids know what RSVP means?  Although it is French, surely everyone still knows it means “reply if you please”. Has RSVP been replaced by LOL and OMG? It is a common courtesy to respond to an invitation and one that all children need to learn (maybe some adults as well). 

Over the years I have had to explain this courtesy to my own children. Sometimes they just did not understand why I bugged them to reply in a timely matter.  After looking at the bulletin board where I would put check marks and dates by our response, I would often ask them if they had replied as well? This question was often answered with, “Not yet, trying to decide, or “ They know that I am coming ” or lastly “ I’ll do it later”.  Such answers did not seem to be exactly what I had hoped to hear. Of course, I couldn’t relent until we had closure on this issue and I knew that they had responded.  I was the bothersome mother after all!

For many years they seemed clueless as to head counts and party prep. I would re-iterate that by getting an idea of how many people are going to attend any event the hosts can make sure that there are enough seats for everyone coming, or enough food to eat and drinks for all. Otherwise, you either spend way too much over buying or end of scrounging as you didn’t plan on that many people. “Whatever”, right? 

Well, now that they are older, they were just complaining to me that they had not heard from guests for a party that they were planning. “How do I know how much food to order?”, “How do you rent tables and chairs if you don’t have a head count?”  “Why do people wait till the last minute to reply?”  “Didn’t their parents bug them about replying?”  And finally, music to my ears, “Mom you should write a blog about learning to reply to invitations”! 

So...here it is. Teach your kids (beginning at early ages) how to reply to a party. Have them pick up the phone to reply to the 5 year old birthday party, or learn to write an email response when they are accepting an invitation to attend an event. Teach them to reply in a timely manner, and if something does change, let the hosts know.  Lastly, I still don’t see any reply messages that say “text me if you are coming”, but I am sure that is just around the corner.  

Good manners are ageless and timeless.

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