Elementary school kids Archives - Page 27 of 40

The Jersey Shore: pediatric style

We’re back from a Jersey Shore medical conference where we moderated the adolescent session of the Atlantic Regional Osteopathic Convention. In the next few weeks, we’ll be posting you advice gleaned from talks on teen depression, vaccine updates, fatigue in adolescents and worrisome teen drug use trends.

Today we start with advice based on Dr. Melisa Lai Becker’s talk, Trendy Tox Teen Behaviors:

How do I know if my kid is high? Your tween or teen wanders in late on a Saturday night and acts like he is in slow motion. “I’m just tired,” he claims. Is he high, you wonder? To answer the question, have him look you straight in the eye as you talk to him. Even if he is lying, the truth will be in his eyes. More specifically, it’s in the size of his pupils (the black part of his eyes). Too big (nearly covers the colored part of his eyes) or too little (like pinpoints) is a sign he is currently high.

Alcohol: Parents, beware. The type of alcohol in your beer, ethanol, is the same type of alcohol in your morning mouth wash and perhaps in your medicine cabinet. The difference is that mouthwash contains more alcohol than beer. Beer typically contains up to 5 percent ethanol, wine up to 14 percent ethanol, and liquors usually up to 40 percent ethanol. Compare this to Original Listerine with 27 percent ethanol and Nyquil Nighttime Cold/Cough with 25 percent ethanol (and you wonder why it helps you fall asleep?!).

How can you tell if your kid is drunk? Again, look at his eyes- if he is drunk you may see pupils dancing in small circles. The dancing eyes give the sensation of “dizziness” to drunk individuals.

Pharming: We teach our children that medicine is not candy, and yet Pharming—consuming prescription substances to get a high—is a big problem among teens. Since 2003, according to the Centers for Disease Control, more overdose deaths have involved painkillers like Vicodin and Percocet than heroin and cocaine combined. Among teens, medications prescribed for Attention Deficit Hyperactivity Disorder are the most popular pharmed drugs. Don’t unwittingly contribute to a pharming party where kids raid medicine cabinets, deposit pills into big bowls and randomly ingest them. This upcoming week, April 28, is National Prescription Drug Take-Back Day . Make it a spring cleaning priority.

The most important phone number parents (and doctors) can know:

poison control: 1-800-222-1222

Melisa Lai Becker, MD, is chief of Emergency Medicine at the Cambridge Health Alliance at Whidden Memorial Hospital campus in Everett, Massachusetts. She also serves as Director of Medical Toxicology of the Cambridge Health Alliance and as a Harvard Medical School instructor.

Naline Lai, MD and Julie Kardos, MD
©2012 Two Peds in a Pod®

How can I motivate my child in school? — Creating the resilient learner

“What will happen if your grade drops from an “A” to a “C”?” I sometimes ask during a check-up.

Many kids shrug and say, “Try harder next time, I suppose.” Others look shocked and anxious about the possibility and are speechless.

Still others will point at their parents and say,”THEY would kill me.”

Observe a toddler learning a new skill. You will see him repeatedly try to fit a ball into a hole until he is either successful or wanders way. He is not anxious or afraid of failure. He is not “stressed” about trying to learn. Although all children start this way, too often toddlers become big kids who end up in my office discouraged and worried about school performance. Today’s guests Principal Mr. Leonard Schwartz and Vice Principal Michael Testani, based on the work of Dr. Carol Dweck, discuss ways parents can influence their children so that they embrace learning.

– Drs. Lai and Kardos

Researchers under the leadership of Dr. Carol Dweck conducted a survey of parents of school aged children. The majority of parents thought it was necessary to praise their children’s intelligence in order to give them confidence in their abilities and motivate them to succeed. Instead, this approach can lead to fixed mindsets in children. Kids with fixed mindsets believe “my abilities are what they are.”

Instead, the most motivated and resilient students demonstrate a growth mindset. They are the ones who believe their abilities can be developed through their effort and learning. These students are resilient and persevere when tasks become challenging.

A study of students’ brain waves revealed students with a fixed mindset were interested in whether they got an answer right or wrong, but when they were wrong, they paid little attention to the correct answer. Students who were praised for their intelligence later lied about their scores. They felt the errors were so humiliating that they could not own up to them. The students failed to persevere, believing they were no longer “smart,” and therefore unable to meet academic challenges.

Students with a fixed mindset typically think it is best if they:

Don’t make mistakes – “I’m too smart to make mistakes.”
Don’t need to work hard –”I’m smart and learning comes naturally to me.”
Don’t try to repair mistakes- “I was wrong, and that is the end of it.”

Students with a growth mindset generally:

Take on challenges
Work hard
Confront their deficiencies and correct them

How should parents talk to their children in order to develop a growth mindset?

Wow, you got 10 out of 10 right! What strategy did you use to get a perfect score?
What can you learn from this mistake that will help you do better next time?
I am proud of how hard you worked on this project and look at how your hard work paid off!
The strategies you used last time didn’t work. Let’s take a look at them so I can help you figure out better strategies to use next time.
You’re becoming such a good learner!
Smart is not something you are; it’s something you become. Let’s figure out how you can become smart at this assignment.

What is your child’s mindset? Ask yourself, what is your own mindset? Have a conversation with your child as you discuss your child’s report card. Use any upcoming parent teacher conference to examine outlooks, attitudes, and strategies that are or are not supporting your child’s academic progress.

Where applicable, praise your child’s positive skills and attributes. Celebrate instances you observed that contributed to positive indicators.

When necessary, examine areas of poor performance and strategize with your child about how he or she can turn a weakness into a strength. Again, you may revisit situations you observed this past grading period in which your child took shortcuts, provided incomplete work products, or did not do his or her personal best.

Make your expectations very clear in terms of why you value attributes or traits of resiliency, and how they can and will develop into habits that will serve your child well.

Grades are a distant second to the level of effort a child invests in personal learning in any setting.

Leonard H. Schwartz, Principal, Mill Creek Elementary School

Michael R. Testani, Assistant Principal, Mill Creek Elementary School

Mr. Schwartz and Mr. Testani are part of the Central Bucks School System in Pennsylvania. After fourty-three years as an educator in two school districts and five schools, Mr. Schwartz retires this year. This post was published in it’s full original form in the publication Principal’s Prose of Mill Creek Elementary School.

Potty Talk: the “Scoop On Poop” on philly.com

We’re pleased to bring to the Greater Phildaelphia Area our “Scoop on Poop” post which was published in the Healthy Kids blog for Philadelphia Inquirer’s philly.com.

Although many can not talk about the topic without snickering, face it. “Poop” is an essential of life. If pooping gets thrown off, everything gets thrown off. The kid who won’t poop in the potty sets everyone else in the household off kilter, and leads to bribes, threats and chaos. A constipated kid is a grumpy kid. Constipation can lead to tantrums, refusal to eat, and even an inability to fall asleep. If you still have have infant and toddler poop questions, check out our podcast on potty training and our post “When potty training gets hard: constipation.” On a related topic, please also visit our post “It’s a Gas, your young infant’s burps and farts.”

Until you are a parent, you can never fully appreciate the fierce desire for “everything to come out okay in the end.”

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

Some like it hot: Hot Tub Folliculitis

hot tub rash From the start, a family I know was suspicious of the hot tub sanitation at the resort where they recently stayed. As time went by, even though the water looked clear, the hot tub seemed less chlorinated, and the water more tepid. They dubbed the tub “the scuz tub.” After their return, one of the kids broke out in the rash of hot tub folliculitis pictured to the left. You could say, they figured out just what the “scuz wuz”.

Hot tub folliculitis is a skin rash caused by a bacteria called pseudomonas aeruginosa. The rash appears a day or two after soaking in a hot tub. A light pink bump appears around hair follicles (hence the name). As you can see in this photo, the rash is typically worse on areas of skin where bacteria was trapped under a swimming suit. The rash can cover all body surfaces, including the face, if your child dunked his head under water.

The rash can be slightly itchy but is not usually painful. No other symptoms develop such as fever or sore throat. The rash is not contagious, but often other people who swam in the same hot tub also break out.

Treatment is to wait it out. Typically by one to two weeks, provided your child does not go back into the hot tub, the rash resolves on its own. If your child feels very itchy, you can treat her with oral diphenhydramine (brand name Benedryl). Rarely, just like mosquito bites, the rash can become infected with other bacteria if your child scratches too much.

Pseudomonas thrives in warm wet places. In fact, it’s the same bacteria that causes “swimmer’s ear.” Tight control of chlorine and acid content of the hot tub water limit the growth of the bacteria. Unfortunately, you can not tell the pseudomonas content of water just by eyeing it.

May you bring back a better souvenir than this family did on your next vacation.

Julie Kardos, MD and Naline Lai, MD

Hail to the Tooth Fairy: young school age child development

The Tooth Fairy rocks!

For kids, the Tooth Fairy takes the worry out of the stage around five to seven years when they start to worry about their “body integrity.” Kids are concerned about keeping their bodies intact. This is the age of Band-Aids and boo boos, of skinned knees on the playground and falls from bikes without training wheels. When a child loses her tooth, a PIECE of her BODY falls off. Often the child experiences discomfort as the tooth gets very loose. Many become anxious and have difficulty eating when the tooth gets to the “hanging by a thread” state. Kids BLEED if they lose a tooth by biting into an apple or knocking into something. Yet adults convert this potentially anxiety-provoking event of losing a tooth into an exciting rite of passage. Without the Tooth Fairy, we’d have a batch of kids mortified by a normal physical change. Who ever invented the Tooth Fairy was a GENIUS!

Our patients have taught us interesting “facts” about the tooth fairy over the years:

Some tooth fairies leave the token under the pillow, others leave it at the bedside.
Some tooth fairies leave money, others a small toy, and some write messages.
Some tooth fairies are boys and some are girls.
Some look like Tinker Bell and others look like trolls.
Some tooth fairies don’t have change for a twenty dollar bill.
Tooth fairies can look like someone the child already knows, even a mom or dad!
Tooth fairies can sense a missing tooth even if the child loses the tooth on the playground or swallows it by mistake, so it’s okay if the tooth is not left under a pillow for the Tooth Fairy. She’ll still come.

Pediatrician dentists recommend children begin regular dental visits within six months of getting their first tooth. Most babies get their first tooth between four months and twelve months, so by eighteen months of age your child should have had her first dental visit. Don’t forget to start brushing as soon as that first tooth appears. With this being said, it isn’t just kids who need to look after their teeth. No matter what age you are, you should clean your teeth at least twice a day.

It’s okay to brush with water alone or use a baby tooth and gum cleaner. Add toothpaste by age two years, when kids can learn how to spit. Ask your dentist or pediatrician about fluoride supplementation if there isn’t any fluoride in your water supply. For more tooth tips see our guest blog post by Dr. Paria Hassouri and take advantage of this free tooth brushing chart which you can personalize with your child’s name. Take good care of those primary teeth, even though they are destined to be taken away by the Tooth Fairy.

Julie Kardos, MD with Naline Lai, MD

Dr. Kardos feels nostalgic. Her oldest child, who stopped eating for the two days before his first baby tooth fell out, just lost his last baby tooth last week. And yes, the Tooth Fairy did visit her twelve-year-old.

Cinnamon Challenge = Potential Choking Calamity

Do not take the cinnamon challenge Beware. There’s another choking “game” out there. This time, kids try to swallow a teaspoon (or more) of cinnamon without water as quickly as possible without coughing or vomiting. The cinnamon usually forms a thick slurry in the back of the throat and causes gagging and coughing. Hence, the “cinnamon challenge.”

We first saw warning reports of the cinnamon challenge via recent emails circulated by principals in local school districts, but yesterday Dr. Lai heard about it directly from a kid and his mother in her office. Luckily, the teen and his friends who played it the other day were fine. However, everyone did cough after taking in the cinnamon and one kid in his group threw-up.

“Do you know why people cough?” I asked him.

“Why?” he said.

“It’s a sign your body is trying to protect your airway,” I said.

The trend is spurred on by kids trying to copy YouTube videos and Daniel Tosh on the television show Tosh.0

Current statistics for emergency room visits or deaths related to this particular “game” are hard to come by. But we do know in 2000, according to the Centers for Disesase Control, 160 children aged 14 years and under died from airway obstruction associated with inhaled or ingested foreign bodies. Food was associated with about 40% of those deaths. Especially for those who already have sensitive airways such as those with asthma, any substance which tickles the back of the throat can produce spasm in the lungs. Also, the substance itself can get into the lungs.

Tosh starts off the video above by saying, “The internet is full of challenges.” Well, we’re on the internet too, Tosh, and we challenge you to model the healthy behaviors – not the dangerous ones.

Naline Lai, MD and Julie Kardos, MD

How to treat bloody noses- nothing to sneeze at

Our fantastic Two Peds in a Pod photographer Lexi Logan recently put in a request for a post on bloody noses. I cringed, thinking any photo would not be pretty. “No problem,” she replied,” I’m thinking just a tissue and a top-of-nose shot… pinch angle.”

I was aghast. “Looks like you fell for the number one myth associated with bloody noses,” I said.”That’s the wrong spot to pinch.”

“See,” she told me,”that’s why I need the post.”

So, how does one squelch the fountain of red which spews from a bloody nose? Apply pressure to the SIDE of the nostrils—not up near the bridge of the nose. More blood vessels lay near the bottom of the septum, the divider which separates the nostrils, than near the top. Pinch the nose firmly. Since kids never seem to apply enough pressure on their own, go ahead and pinch for them. You’ll find it easier to pinch both nostrils simultaneously even if the blood is dripping from only one side.

Now hold. Hold. Hold. Hold in the middle of the night until you nearly fall back to sleep. Hold until the pot of spaghetti boils over. Hold for at least ten minutes before peeking in order to allow the blood to clot. If the nose is still oozing, pinch for another ten minutes. Have your kid sit up straight or lean slightly forward. Otherwise, blood will drip down the back of her throat and cause nausea and vomiting.

Do not be surprised after an episode if the next couple of nights bring more bloody noses. At night during sleep kids tend to rub their noses. Any scab that formed from a recent nose bleed gets sloughed off.

To prevent reoccurrence, protect those fragile blood vessels by keeping the inside walls of the nose moist. Once or twice a day, spritz saline into the nose, then apply a thin layer of petroleum jelly. Try running a cool mist humidifier in your child’s bedroom.

Prevent nasal irritation by decreasing environmental irritations such as cigarette smoke or dust. Teach your child to dab at his nose or blow gently when he has a cold. Ironically, some steroid nasal sprays, which treat runny noses caused by allergies, can irritate nasal passages.

Your kid is having too many bloody noses when you start to carry around tissues or your child sleeps with a box of tissues next to his pillow “just in case.” Go to your child’s doctor if this occurs. Also, go if there are signs of a clotting problem such as easy bruising, bleeding gums, or heavy periods. Likewise, if bloody noses take more than twenty minutes to clot, or if the nose bleed requires an emergency room visit or packing in the nose, make an appointment. Other reasons for more evaluation include if your family has a history of clotting disorders, your child gets speckled flat rashes that look like broken blood vessels (petechiae) which do not blanch (lose color for a second when you press on it) or if a nosebleed is caused by trauma.

Your child’s doctor may recommend sealing vessels with cauterization or investigating for possible blood clotting problems. Depending on your child’s age, she may also recommend a short course of oxymetazoline (eg Afrin). Be sure to use oxymetaxzoline according to directions- overuse can cause rebound symptoms.

Ultimately, you may find that your kid’s bloody noses are just the result of the perfect storm: dry air and a kid who picks his nose. In the meantime save that thirty percent-off Kohl’s coupon. You might be buying a lot of pillow cases.

Naline Lai, MD and Julie Kardos, MD
©2012 Two Peds in a Pod®

Podcast: The barky cough of croup

You wake up in the middle of the night to the sound of a seal barking inside your house. More specifically, from inside the crib or toddler bed. Unless you actually have a pet seal, that bark is the sound of your child with croup.

What is happening and what to do? Press play here to listen to our latest podcast:

Julie Kardos, MD and Naline Lai, MD

Make every bite count: how to increase calories for underweight children

Although the United States is in the midst of an obesity epidemic, some children are underweight. Your child’s pediatrician charts your child’s height and weight in order to determine whether he is growing appropriately. Just as obesity has many causes, kids can be underweight for many reasons. Regardless of whether the cause of your child’s poor weight gain is medical or behavioral, the bottom line is that underweight kids use more calories than they take in.

Here are ways to increase calories. Remember, you cannot force children to eat if they are not hungry. For example, you can’t just demand that your child eat more noodles. Instead of trying to stuff more food into your child, increase the caloric umph behind a meal. Make every bite count:

Mix baby cereal with formula, not juice or water.
After weaning formula, give whole milk until two years, longer if child is still underweight.
Add Carnation Instant Breakfast or Ovaltine to milk.
Add Smart Balance, butter, or olive oil to cooked vegetables, pasta, rice, and hot cereal.
Dip fruit into whole milk yogurt
Dip vegetables into cheese sauce or ranch dressing
Offer avocado and banana over less caloric fruits such as grapes (which contain only one calorie per grape).
Cream cheese is full of calories and flavor: smear some on raw veggies, whole wheat crackers, or add some to a jelly sandwich
Peanut butter and other nut-butters are great ways to add calories as well as protein to crackers, sandwiches, and cereal.
If your child is old enough to eat nuts without choking (as least 3 years), a snack of nuts provides more calories and nutrition than goldfish crackers or graham crackers.
For your older child feed hardy “home style foods.” Give mac ‘n cheese instead of pasta with a splash of tomato sauce or serve meatloaf with gravy instead of chicken breast
Try granola mixed into yogurt or as a bar.
Give milkshakes in place of milk (no raw eggs!)
Choose a muffin over a piece of toast at breakfast.

Some causes of poor weight gain are medical. Have your child’s doctor exclude medical reasons of poor weight gain with a thorough history and physical exam before you assume poor weight gain is from low caloric intake. Sometimes, your child’s physician may need to check blood work or other studies to help figure out why he is not gaining weight appropriately.

Some common behavioral causes include drinking too much prior to eating, picky eating, or parents failing to offer enough calories. Sometimes tweens and teens develop a pathologic fear or anxiety about gaining weight and deliberately decrease their food consumption. These kids have eating disorders and need immediate medical attention.

A common scenario we often see is the underweight toddler whose parents describe as a “picky eater.” Meal times are stressful for the entire family. Mom has a stomach ache going into dinner knowing the battle that will ensue. Her child refuses everything on the table. Mom then offers bribes or other meal alternatives. Dad then gets into the fray by making a game out of eating, and when the child does not eat, in frustration he yells at the child. Grandma then appears with a big cookie because “well, he needs to eat SOMETHING.” All the adults end up arguing with each other about the best way to get their toddler to eat. If you recognize your family in this example, please see our post on how to help picky eaters for ways to break out of this cycle.

Just as obese children need to see their doctors to check for complications relating to their increased weight, underweight children require weight checks to make sure that they gain enough weight to prevent poor height growth and malnutrition.

About gender identity: when your boy says he is a girl or your girl says she is a boy

The news is filled with stories about boys wearing pink nail polish, a baby whose gender will be kept a secret by his/her parents, and Chaz Bono’s new book and identity as a man. What’s the deal with gender, and why have the media waves exploded in the past few years? Is gender variance becoming more common, or just more recognized? And what should you do if your son wants to wear pink or your daughter cuts her hair short?

First, some definitions.

–Gender is one’s internal sense of self as male, female, or neither, while sex is assigned at birth based on external appearance. As one astute child told me, “sex is what’s between your legs, while gender is what’s between your ears.”

–Gender expression is how one chooses to portray his or her sex or gender—for example a male child (sex assigned at birth) who feels he is a girl (gender) might still wear boys’ clothing and hairstyles to fit in with peers (gender expression). Or, a female child (sex) feels she is a girl (gender) but prefers to wear boys’ clothing (gender expression) and chooses a gender-neutral name. Her gender expression is masculine.

–Gender variant, gender diverse, and gender nonconforming refer to a child who expresses gender identity or expression that is different than what one expects based on sex. These terms refer to a wide range of children—from the little boy who likes to play with Polly Pocket dolls to the male child who insists he is a girl and wears dresses to school. Some gender variant children will be transgender, which refers to a child who persistently feels the sex assigned at birth is incorrect.

When gender variant children reach puberty, they may become aware of their sexual orientation, or who they are sexually attracted to. They may find that they are attracted to the “opposite gender” and have a straight (heterosexual) orientation, or they may be attracted to the same or any gender, and identify as gay, lesbian, or bisexual. Of course, these labels become especially confusing when discussing gender variant teenagers. For example, is a female-bodied teen who identifies as a man (transgender) and attracted to women heterosexual or homosexual? For this reason, many young people choose to identify as queer, an umbrella term with a positive connotation that conveys many ways of loving people with different bodies and gender expressions.

How common is gender variance?

International epidemiologic studies estimate the prevalence of transgender adults to be anywhere from 1 in 1,000 to 1 in 30,000. That’s a huge range. When you include children who are gender variant but not transgender, the numbers are much higher. For example, Gender Spectrum, an organization that I work with in California, conducts trainings at schools that have identified a gender variant child who is facing bullying or discrimination. To date, they have been invited to nearly every elementary and middle school in their geographic area. Most schools in this area have approximately 100-500 students, so my best estimate of gender variance in my geographic area is 1 in 500.

How do you know if a child is gender variant?

The child tells you. Many of the gender variant children I know recall telling their parents at an early age that they felt different. For example, some transgender boys (i.e. born in a female body, identify as male) I know corrected the adults who tried to call them girls as children, insisting they were boys. One parent recalls her transgender son telling adults “I am a boy now, but when I grow up I will be a mommy.”

Most kids exhibit some sort of gender exploration in their early childhood, and this is a normal part of development. However, a child who is shows gender variance generally makes claims that are early and persistent, and then develops distress when corrected by adults. The “test” becomes when a child is given the freedom to express his/her internal sense of gender. In gender variant children, this distress will be alleviated.

What do you do if this describes your child?

The emerging consensus among experts is to let your child guide you, and to aid your child in his or her gender exploration by working with local resources to create a supporting and accepting environment. In the past, some experts recommended a sort of reparative therapy, for instance removing all “girlish” toys from a boy-bodied child’s home and insisting that he wear only “masculine” clothing. While this may have worked for a short time, the child’s distress often emerged later on, often in puberty, with depression and suicide. In fact, a survey of transgender adults showed that one-third of them had attempted suicide in their life, some as young as age seven or eight. These are good reasons to pay attention to your young child. Research shows that children raised in supportive families have more positive outcomes.

Parents raising gender variant children worry about their safety and acceptance in their schools, neighborhoods, and extended families—and for good reason. Gender variant children are bullied and face discrimination, abuse, and violence at rates much higher than their peers. Often, parents do not agree with each other—as one parent may allow more gender exploration than the other. The child’s gender presentation may not be accepted in churches or within the family’s religious belief. It is imperative that families obtain professional help, especially when there is disagreement between parents on how to support the child. In addition, there are many parents groups and conferences where families can meet each other for mutual support.

If you are concerned about a child in your own life, there are wonderful organizations that can help you.

Resources:

Resources: Gender Spectrum www.genderspectrum.org

Family Acceptance Project http://familyproject.sfsu.edu/

Trans Youth Family Allies http://www.imatyfa.org/

My favorite blogs, articles, and videos about raising Gender Variant Children

Sarah Hoffman’s Parent Blog http://www.sarahhoffmanwriter.com/

A Boy’s Life from the Atlantic http://www.theatlantic.com/magazine/archive/2008/11/a-boy-apos-s-life/7059/

Two Families Grapple with Son’s Gender Identity from NPR http://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences

Transgender Kids recent CNN segment http://www.cnn.com/2011/09/27/health/transgender-kids/index.html

Ilana Sherer, MD

Returning guest blogger Dr. Ilana Sherer is the Director of General Pediatrics of the Child and Adolescent Gender Center at UCSF. She is a recipient of the Chancellors Award for LGBT leadership at UCSF and also of the American Academy of Pediatrics Dyson Child Advocacy Award.