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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

Kids And Headaches

1:30 to read

A recent study suggests teens and chronic headaches go together. This interesting study revealed about 1-2% of adolescents have chronic daily headaches, defined as more than 15 headache days per month for greater than 3 months.

When school begins, teens stress levels increase with each week of school, and with that come more complaints of  chronic headaches.  It is not unusual for me to see several teens a  week  who complain that they have headaches every day. Despite these persistent headaches, the majority of se adolescents continue to participate in their school activities, sleep well once they fall asleep and spend their weekends doing whatever it is that teens all do. I see very few teens who look like they are in “severe” pain, although they state that their head is “killing” them while they chatter away about where it hurts, and how often it hurts etc. It is quite reassuring to watch their faces and expressions as they go into detail about their headaches.  In these cases it is important to obtain a good history to rule out any underlying pathology, as well as to inquire about family history of migraines. In this study, the authors followed adolescents ages 12–14 years who met criteria for chronic daily headaches. They followed the group after both 1 and 2 years, and then again after 8 years. The results showed that after 1 year, 40% of adolescents still complained of chronic headaches.

After 2 years, only 25% reported headaches.  After 8 years, only 12% reported chronic headaches. Most participants reported substantial or some improvement in headache intensity and frequency during the 8 year follow-up. The most significant predictor for ongoing problems with headaches was onset of chronic headaches before the age of 13 years.  For the most part 75% of adolescents with chronic daily headaches improved over the 8 year period which is quite reassuring. This study just seemed to confirm that teens and headaches go together.  If a good history and physical exam is performed and there seem to be no underlying problems that contribute to their headaches, it is best to discuss the natural history of chronic headaches.

I think it is important to spend time with adolescents to explore ways to alleviate stress as a trigger for chronic daily headaches. Basic changes in lifestyle such as healthy eating, regular exercise, and a good night’s sleep will often help reduce headaches.  Relaxation techniques and cognitive behavioral therapy may also be utilized. At least we know that the headaches reduce with time, maybe just a maturational process, like many things!

That's your daily dose for today.  We'll chat again tomorrow! Send your question or comment to Dr. Sue! Send your question or comment to Dr. Sue!

Daily Dose

Paddling in School

1:30 to read

I just finished reading an online post from a pediatrician in another state whose daughter has just started kindergarten. It seems that in her state, and her school, they may still “paddle” children for misbehaving. WHAT?!?!

In fact, the school sent a note home with her child that re-iterated the “school rules” surrounding paddling and asked that the parent sign the note that they agreed to paddling. Are you kidding me…what parent would sign a note agreeing to let someone HIT their child?  Parent’s have been arrested for spanking their children in a public place….but now you can let someone else paddle your child? 

I talk to parents about discipline even before their child turns one. Many a parent will tell you I am “the strict” doctor.  From the beginning, I discourage spanking (although I will admit to spanking my own children several times during their childhood - usually out of total frustration and never felt good about it) and begin with some simple strategies. For example when your 6-7 month old learns that they can make a new shrieking sound to get attention “ignore the behavior” and it will often go away.  Or, what about telling your child that you “will not pick the food up off the floor if they throw it” and then following through….they will not go hungry I assure you.

As children get older I discuss re-directing, time-out, taking away a toy.  For the older child it may be taking away screen time, missing a birthday party and for the teens taking away the cell phone,car or being grounded at home with parents.  But spanking and paddling is never part of the discipline/behavior modification discussion. And now I find out that there are still 19 states that allow paddling in their schools!! 

The mother of this child had not been aware of this rule. She could not believe that she was asked to sign a form to allow her child to be paddled. In this case we are also talking about 5-7 year olds who are just starting school where they will begin to learn school rules and expectations of kindergarten and 1st graders. Every teacher seems to have many strategies for discipline and behavior modification. Not one that I spoke with mentioned spanking or paddling. I am not sure that I even agree with taking away “recess” for misbehaving from this age group…(another conversation)  but certainly not corporal punishment.

The interesting part of this story is that the behavior issues were related to little boys “playing guns”  while they were on the playground. The school has a “zero tolerance for acting out play with guns”  but allows you to hit a child???  What kind of mixed message is that about violence? I know that while raising our three sons, despite our protests about violence and guns,  they seemed to turn anything we gave them into a “play gun” and that was long before they were ever even given a Nerf gun. 

Do your schools have policies regarding corporal punishment? I feel as if I have gone back in time 50 years - only all of this information came from that entity called the internet!!!

 

Daily Dose

The Morning Clothes Battle!

Tired of arguing with your kids about what to wear to school? Dr. Sue has a few tips to end the morning clothes battle!"I don't want to wear that! I can dress myself!" Ah, the morning clothes battle.  Demmeke sent me an email via our  iPhone App and she said she is not ready to surrender in the "what to wear to school" war with her kids.  She has girls!

Actually, the struggle over choosing clothes may be a struggle for either gender and interestingly may start at young ages.  The best time to begin good habits and decrease “the morning clothes struggle” is when your children are young. One of the first things I learned as a  parent was that it was easier to lay out the clothes the night before.  If you let each child help decide the night before and have the “rule” that once chosen that is what will be worn in the morning, everyone knows what to expect. I do remember one of our children always wanting to wear one of 2 favorite Nike sweat suits. He had a blue and a red one. We did go through some struggles about his choice of school clothes until I decided that a “slightly worn” nylon sweat suit was not the worst thing in the world and he managed to wear them for 5 days and only required 1 washing.  Some times you just have to choose your battles and that was one that I finally decided was not worth fighting. After about a year of blue and red “suits” as he liked to call them, I think he moved on to other choices. I also think that school uniforms make everyone’s life easier.  Once our children were required to wear a school uniform (in both public and private schools) I realized that it would be pure genius to have all school children in uniforms. I know that some feel that making all children wear a uniform” stifles their creativity” or something along those lines, I disagree. Uniforms are a great equalizer and put everyone on the same playing field. It is analogous as to why we don’t serve soft drinks in school. If you want to let your son or daughter wear t-shirts with weird messages on the front or inappropriate shorts or tank tops after school while drinking soft drinks, that is a parental decision. But to make teachers and principals spend time “policing” clothes choices seems to be a huge waste of teaching time, especially when our schools are in dire need of academic improvements. There have been numerous studies to show that children actually behave better in school and also have improvement in grades when uniforms are worn.  I thought my own children were creative enough choosing either a white or blue shirt and life seemed easy. I also think it is far cheaper to buy uniforms than to try to stay up with the latest trend in often expensive items. Lastly, I do recall some parents telling me that by sending your child to school in pajamas when they don’t want to get ready in the morning often “fixes” the clothes battle.  Fortunately that is one parenting experience I never had to do, but let me know if that works for you! That's your daily dose for today. We'll chat again tomorrow. Send your question to Dr. Sue!

Your Child

Study: Exercise, Once Again, Improves Kid’s Learning Skills

2:00

While the debate on whether to bring back recess to school curriculums continues across the U.S., a small study from the Netherlands once again shows that adding exercise to a child’s school day can improve their learning skills.

Researchers worked with 500 children in second and third grade, giving half of them traditional lessons while the rest received instruction supplemented with physical activity designed to reinforce math and language lessons.

The approach was a creative and unique way to helping children better comprehend math and spelling.  Instead of taking a recess break – exercise was actually incorporated into the lesson.

After two years, children who got the physically active lessons had significantly higher scores in math and spelling than their peers who didn't exercise during class.

"Previous research showed effects of recess and physical activity breaks," said lead study author Marijke Mullender-Wijnsma, of the University of Gronigen in The Netherlands.

"However, we think that the integration of physical activity into academic lessons will result in bigger effects on academic achievement," Mullender-Wijnsma added in an email to Reuters Heath.

Mullender-Wijnsma and colleagues developed a curriculum that matched typical lessons in academic subject matter but added physical activity as part of instruction. They tested it in 12 elementary schools.

Here’s how it worked.

Lessons involved constant practice and repetition reinforced by body movements. For example, children jumped in place eight times to solve the multiplication problem 2 x 4.

Children in the exercise group received 22 weeks of instruction three times a week during two school years. These lessons were up to 30 minutes long, and evenly split between math and spelling instruction.

During the first year of the study, there wasn’t a great deal of difference found between the students receiving exercise during the class and those that didn’t, when speed was the focus in the math tests.

However, after two years, children who received exercise-based instruction had significantly higher scores on the math speed exams than students who didn't. The difference over two years equated to more than four months of additional learning for the students who had physically active lessons.

When the focus was on lesson comprehension, students receiving exercise outperformed students who did not receive the exercise instruction in both the first and second year. Again, the progress amounted to about four more months of learning.

For spelling, there wasn't a significant difference between the student groups after one year. But by the end of the second year they did have significantly better test scores, once again, adding an additional four more months of learning.

For reading, there wasn’t much difference between the two groups. It's possible that physical activities may be more beneficial to learning that involves repetition, memorization and practice of lessons from previous classes, the researchers conclude.

Researchers did point out that there were limitations that could have impacted the results of the study during the first year. The exercise group received specially trained teachers and individual schools administered the tests.

The research team did not examine why exercise might have helped students do better during tests.

 Sara Benjamin Neelon, of Johns Hopkins University and colleagues write in an accompanying editorial that it’s not clear whether these types of classes would work in countries where the population is larger, more diverse and students come from different socioeconomic backgrounds.

"However, the take-home message for parents and teachers is that physically active lessons may be a novel way to increase physical activity and improve academic performance – at the same time," Benjamin Neelon said by email.

More and more studies show that exercise appears to help the brain function better in children and adults. Whether all U.S. school administrations will see adding recess or exercise back into school curriculums is anybody’s guess, but according to science – it sure couldn’t hurt and might even help students develop stronger learning skills.

The study was published in the online journal Pediatrics.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-children-fitness-learning-idUSKCN0VX26V

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

Start the Back-to-School Sleep Routine Now

2.00 to read

Getting back into the routine of school days also means getting back to good bedtime routines.How can it be that school is just around the corner? Getting back into the routine of school days also means getting back to good bedtime routines. With that being said, you have to start the process now to ensure plenty of time to slowly get bedtimes re-adjusted. By starting early you can avoid the battles that some parent’s talk about when discussing bedtimes.

Children need a good night’s sleep to wake up happy, rested and ready to learn. Numerous studies have shown that elementary age kids need about 10 hours of sleep a night while tweens and teens still need a good 8 – 9 hours of sleep. I wonder how many children really get the recommended amount of sleep? I think too few. Unfortunately, I know from my own experience that teens seem to operate on a different sleep schedule and rarely are in bed as early as they should be. Most of us have relaxed bedtime a little during the summer and children are staying up later and sleeping longer in the mornings. This is great during the lazy summer months, when schedules are also different. But within a few weeks the morning alarms will ring forcing everyone to get up earlier to get to school. In order to try and minimize grouchy and tired children (and parents too) during those first days of school, going to bed on time will be a necessity. Working on re-adjusting betimes now will also make the transition from summer schedule to school schedule a little easier. If your children have been staying up later than usual, try pushing the bedtime back by 15 minutes each night and gradually shifting the bedtime to the “normal” hour. At the same time, especially for older children, you will need to awaken them a little earlier each day to re-set their clocks for early morning awakening. Why is it that pre-school children want to get up early, no matter what, while school-aged children are happy to sleep through alarms?  Such is life. Also, make sure that you are not only ensuring that you children get a good night’s sleep during the school year, but they also awaken in time for breakfast! Just like my mother used to say, “breakfast is the most important meal of the day’” and that adage is still true. A good night’s sleep followed by a healthy breakfast has been shown to improve mood, attention, focus and over all school performance, as well as even helping to prevent obesity. Start off the school year on the right foot. It is easier to begin with good habits than to try and break bad ones. That’s your daily dose, we’ll chat again tomorrow.

Your Child

Setting Up a Routine for Homework

2:00

If yours is like a lot of families, you’re just not quite ready to face the homework hurdle. But like it or not, after school assignments have arrived and helping your child get into a regular routine can actually make it easier for everyone.

Deborah Linebarger, PhD, associate professor of education at the University of Iowa, has come up with six tips to help families get back in the assignment swing of things.

Be prepared: Even if you’ve already picked up all the supplies your child needs at school, make sure the staples needed to complete assignments are also available at home. Items like pencils, erasers, folders, clips, rulers, computer paper & toner should have their own space and be ready to use if needed. This is also a good time let them set up a special place in the house where they can work undisturbed and with all the supplies they need. You may discover you have a budding interior designer with a knack for organization!

Set A Schedule: You child should do her homework at the same time every day. Many kids need a break after school for a snack and a little running around first. It's best to get homework done as early as possible -- when it drags on past dinner and toward bedtime, the work is likely to take longer and be sloppier.

Bedtime: Don’t leave homework till the last minute, make sure that it’s finished and checked at least a couple of hours before bedtime. Just like adults, children need plenty of good sleep to function well the next day. Preschoolers typically need 11-13 hours each night. Six to thirteen year olds need around 9-11 hours and teens need about 8 -10 hours a night. Make sleep a priority by having a cool, quiet and dark bedroom. Establish an appropriate bedtime for your child and stick to it. Cut off the access to computers, TVS, phones and any electronics at a minimum of an hour before it’s time for sleep. Quieting and slowing down before it’s actually time to nod off can help relax your child.

Break it down. Younger kids might get a week's worth of homework on Monday to turn in by Friday. Older children may have big responsibilities like term papers and science projects. Help them break large projects into smaller steps, and make sure they start early.

Keep up with your child’s assignments so that you’re not surprised by a last minute science project the night before it’s due!

Encourage "peer collaboration" -- to a point. It may be helpful for siblings close in age to do homework together. The older one may be proud and happy to offer help to the younger one. But if they bicker more than they cooperate, it's time for separate spaces.

What if you have a child with ADHD? As you probably already know, children with ADHD are more likely to face extra challenges with completing their homework.

He or she will need even more supervision and guidance, Linebarger says.

"Start by breaking up homework into really bite-sized amounts," she says. "For a younger child, that may be only about 10-minute increments. Expand them slowly as they show they're able to handle it." And expect that your child will need you to watch her homework efforts closely to make sure he or she stays on task.

When they gets distracted -- and they will -- encourage your boy or girl to do something physical to get back on track. "Let her jump up and run around for 5 minutes, or have him do 10 push-ups or 30 jumping jacks," Linebarger says. "Research shows that acute physical activity right before a challenging mental task helps to control behavior."

Children with ADHD often hear a lot of criticism, be sure and compliment them and encourage them when they’ve completed a difficult task.

When they manage to sit still for that 10 minutes of homework, or come home with their homework folder in order, give them lots of praise for making a great choice," Linebarger says.

It won’t be long till summer is a fond memory and the school year is just how things are. You can help your child adjust to this either new or familiar way of getting through Monday through Friday by using the tips above and finding out what adjustments may need to be made to work best for your family.

Source: Gina Shaw, http://www.webmd.com/parenting/features/back-school-homework-routine

 

Daily Dose

Start Good Homework Routines Now

Now that school has started homework has too. For most children homework starts in first grade and continues through out high school. There are often lots of complaints and frustrations about getting homework completed, both from the children and their parents. Like so many things, the best way to begin the school year is with a good plan for getting homework completed.

It is also easier to start younger children with good study habits that will then be maintained throughout their school years. With that being said, do not throw in the towel if you have an older child who still needs a little coaxing and guidance on getting homework done. It is never too late to make changes for the better! To begin with homework needs to be a child’s responsibility. Parents are important helpers with homework, but should not be the doers of the homework. Everyone is a little different as to when homework should be completed. For some it is easiest to come straight home from school and start homework. For others they need some “down time” and may need to run around outside to get rid of some energy before starting homework. You know your child the best, but either way, having a routine to getting homework started is the key to getting it completed. Secondly, good study habits require a good study area. Buying an inexpensive desk to set up a quiet study area will be useful for many years. Setting up this area can be fun for children too and teach responsibility for taking care of their study area. As children get older they will be used to getting their study area organized and this will carry them all of the way through college. Teachers have set expectations for homework, and are a valuable resource in helping you as a parent to know what to expect for the year. Some teachers assign more importance to homework than others; so it is important know this early in the year. Review these expectations with your child too, so that everyone is on the same page. Homework can also be a good time to watch your child at work. This is the only time that you really have a chance to observe how your child is learning. Does it seem that they have a harder time in one area than another? Are there problems with comprehension, or focus? These parental observations are important if there seem to be consistent issues, and if so make an appointment with your child’s teacher to discuss your concerns. Again, doing the homework for them will not correct the issue and tackling learning problems is better at an earlier age. By following good homework basics your child should become independent with their homework and be on the road to a lifetime of good study habits. That’s your daily dose, we’ll chat again tomorrow.

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New study reveals how much sleep kids really need.

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