Breastfeeding moms often ask us what medications they can take and not adversely effect the baby. The most complete database we have found is LactMed . Hope you won’t have the need to refer to it too often.
Whether you are discussing after dinner cleanup or explaining a complex issue such as an impending divorce, keep in mind talking to a young child is not the same as talking to a “little adult.” Our guest blogger, child psychologist Dr. Barry Ginsberg, a child and family psychologist since 1969 and the originator of the Parent-Adolescent Relationship Development Program (PARD), illustrates how to communicate with preschool and young school aged children.
Julie Kardos, MD and Naline Lai, MD
Children’s Questions
It’s important to be receptive to what we call teachable moments. Be prepared to
respond when you perceive that your child is ready and then follow your child’s lead.
Here’s such a moment: Johnny, age three, asks Sam, his dad, “Why do I have to go to day care?”
Sam could explain that it’s important to be with other children, or that he has to go to work. But instead, he realizes that he first needs to respond to Johnny’s feelings. So he says, “You’re not happy about going.”
Johnny says, “Yes, I want to be with you.”
“It makes me feel good that you want to be with me,” Sam says, going to a positive feeling first. Then, he refers to his own feelings by saying, “That’s important to me, too.”
Only after Sam says this does he become specific and answer Johnny’s question with facts: “It’s important to go to day care because I feel better knowing where you are and that you are safe when I’m at work.”
This was a teachable moment. Sam paid attention to Johnny’s feelings, acknowledged both their feelings, and offered a reasonable explanation. This demonstrates Sam’s respect for his son. As a result, Johnny truly “heard” his father.
When talking with young children, keep the following in mind:
- Young children express themselves mostly through play.
- Play is how they go about understanding their world and experiences.
- Letting a young child lead you in play helps you understand the child better.
- It may be hard to get a young child to let you know that she understands you. Forcing her to respond may be threatening to her and frustrating for you.
- Even though children may not seem to be showing you that they understand, they probably do.
- Keep your comments short and simple. As much as possible, try to phrase things in children’s terms, let them know you understand their feelings and use your feelings when you want to let them know what you want. For example, “You’d like to keep playing but I’m unhappy that the toys aren’t picked up,” and “The rule is that toys are put away before dinner.”
- If you want children to understand or do something, you need to be patient; repeat it a few times; gently convey through your movements what you want; and try not to act out of your frustration.
- Try to be consistent, and have clear rules and expectations.
- Pay attention to children’s feelings when talking to them.
Read these nine suggestions over a few times. It takes a little practice to use them consistently. Be patient with yourself. You’ll get it after a while.
Barry G. Ginsberg, PhD, ABPP, CFLE
The Center of Relationship Enhancement (CORE)
215-348-2424
www.relationshipenhancement.com
Reprinted with permission from 50 Wonderful ways to be a Single-Parent Family.
photo credit: Lexi Logan www.lexilogan.com
At a baby’s six month old check-up I advise parents to have their child start drinking from a cup.
Some respond with surprise,” A cup? So young? How exciting! Do you mean a sippy cup?”
“No,” I explain. “A regular, open face cup.”
Then I get incredulous looks. “But how will our baby manage that?”
Just like your baby “learns” how to eat food off a spoon, she will have to practice. You will have to help her at first. Just put water in the cup. Who cares if water spills? You see how by this age she naturally puts her hands together and pulls most things to her mouth. With practice, she will learn to drink out of a cup. Just like everyone else did before sippy cups were invented.
“But when,” parents ask me, “should we introduce the sippy cup?”
The reality is, sippy cups satisfy a parent’s desire to be neat and to avoid mess. Sippy cups are not a developmental stage. Did I use sippy cups with my own kids? Yes I did, especially with my twins, because anything I could do to decrease mess in my home I welcomed with open arms. But it is perfectly okay to never introduce sippy cups to your child.
Because sippy cups are spill-proof, it is tempting to leave one out all day for your child. If the cup contains water, this practice is safe. However, many toddlers have ended up with a mouth full of cavities in their brand new baby teeth after sipping milk or juice all day long out of sippy cups. Constant sweet substances on the gums can sink in and affect baby teeth. Just as we advise parents of bottle fed babies to avoid allowing the child graze from the bottle all day and to avoid falling asleep drinking a bottle, young children should not be drinking sugar-containing drinks, including milk, all day from a sippy cup.
“But I only give my kids water mixed with a tiny bit of juice in the sippy cups,” I hear parents say. Yes, kids (and grownups) need water, but watered down juice is not the same as plain water. Watered down juice is sugar water, and it harms teeth just like straight-up juice. In addition, drinking watered down juice teaches kids that all beverages need to be sweet. Sweet drinks do not actually quench thirst; rather, they make kids feel thirstier. Remember that unlike adults, babies and toddlers have not formed unhealthy habits yet, so teach them that water and milk are for drinking. The only exceptions are electrolyte solutions that are used to prevent dehydration during vomiting and juice once a day (prune, pear, or apple) for constipated children. For nutrition, fruit is much healthier than fruit juice.
So put water in the open faced cup and allow your baby to imitate you and drink out of it. Then, around your child’s first birthday when most parents wean their children from breast milk or formula to cow milk, put the “big boy milk” or “big girl milk” into a cup. Aim for all open cups by at least two years of age. If you decide to use sippy cups, as I did, for neatness sake, do not forget practice with a regular cup. Get rid of the sippy cup whenever you are tired of washing those moldy valves and tired of rescuing them from your drain or garbage disposal. You might have a “sippy cups are for car rides” policy and use open cups at home.
What about straw cups? Well, think of it this way. Do you plan to travel around with straws in case your child becomes thirsty? Sure it’s fine to teach your child to drink out of straw. It’s healthier than a sippy cup because most of the milk will bypass most of the teeth. But again, it is easiest in the long run to teach your child to drink out of a regular cup so that in any situation you know you can offer your child a drink.
All kids are messy. The younger you practice with your child, the sooner she will be drinking out of a regular cup like a pro. Just in time for finger feeding which means self-feeding—more mealtime mess!
Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod℠
This monstrosity arrived at my house last week. It’s the neighborhood snow blower my husband and several neighbors purchased together to share. As I stared at the machine, I thought about all the little arms and legs that could potentially be churned up as the monster chugs through the snow. Paranoid? Perhaps. Although, I console myself, it would be hard to ignore a snow blower coming at you.
Unfortunately, one of the biggest winter hazards is not so loud and obvious. As the temperature drops, deaths rise from this insidious poisonous gas: carbon monoxide.
According to the Centers for Disease Control, about 400 unintentional deaths occur a year from carbon monoxide poisoning. Carbon monoxide results from the incomplete combustion of fuel. The gas causes a chemical suffocation by competing with oxygen in your body. The colorless, odorless gas is impossible for human senses to detect, and unfortunately, loss of consciousness usually occurs before any symptoms appear. Those lucky enough to have warning symptoms before passing out may experience headaches, nausea or confusion.
Because carbon monoxide is a by-product of incomplete combustion, sources are related to energy use. Poisoning occurs more during the winter months when fuel is used to heat closed spaces and ventilation from exhausts is poor. My sister, toxicologist and Harvard medical school instructor, Dr. Melisa Lai, tells the story of a snowplow operator a few years ago who left the house early in the morning to plow snow, only to return and find his family dead. The reason—snow blocked the exhaust pipe from the furnace and caused lethal levels of carbon monoxide to accumulate in his home.
Carbon monoxide also occurs in warm weather. To avoid carbon monoxide buildup in all climates:
–Install carbon monoxide detectors. My sister says a $20 detector such as Kidde works as well as the $150 models. Put them on every level of your home and check that the batteries work. Smoke detectors are not the same as carbon monoxide detectors. However, combination detectors are available.
–Ventilate all appliances, heating units, and your chimney adequately. Have them serviced yearly.
–Be wary of the exhaust from of any vehicle.
Parents have put their infants in running cars while they shovel snow, unaware that the car’s tailpipe is covered in snow. By the time they return to the car, the infant, who is extremely susceptible to carbon monoxide poisoning because of his size, is dead. Even opening the garage door when you run your car is not enough ventilation to prevent poisoning.
Like cars, boats also produce carbon monoxide. Since boats are less energy efficient than cars, they spew more of the gas. While your teen boogie boards behind a motor boat, the carbon monoxide can knock her tumbling unconscious into the water.
–Keep anything meant to burn fuel outdoors, OUTDOORS. Even an innocent barbeque can turn into a nightmare if you decide to grill inside your garage. Emissions from any type of grill, charcoal or gas, can send carbon monoxide levels skyrocketing. Additionally, hurricane season in the southern United States is known by toxicologists as “Carbon Monoxide Season.” During hurricanes, people buy outdoor generators and auxiliary heating units. They work so well that people then bring them indoors, trapping fumes in their homes.
My sister says she has hundreds of stories about carbon monoxide poisoning, all which end tragically. Maybe I’ll let my husband store that larger-than-life-take-up-car-space neighborhood snow blower here this winter. Then, at least I know I’ll be able to make sure no one starts up the blower in a garage.
For more details please visit http://www.cdc.gov/co/faqs.htm.
Naline Lai, MD with Julie Kardos, MD
©2010 Two Peds in a Pod℠
Although the American Congress of Obstetricians and Gynecologists recommends a first gynecological visit between 13 and 15 years of age, a teen usually does not need to have an internal pelvic exam at the first visit unless she is having problems or unless there is a need to screen for certain sexually transmitted diseases.
For more information, please visit http://www.acog.org/publications/patient_education/bp150.cfm.
Julie Kardos, MD and Naline Lai, MD
The American Congress of Obstetricians and Gynecologists in June recommended adolescent girls have their first visit with an ob-gyn between the ages of 13 and 15 to help set the stage for optimal gynecologic health. This visit does not necessarily include an internal pelvic exam. Last month the American Academy of Pediatrics released a policy statement outlining when teenage girls may stay with their pediatrician for routine care. Our guest blogger today, pediatrician Dr. Carly Wilbur, illustrates for us the guidelines.
___________________________
Last week, I saw a 14-year-old young lady who suffered painful menstrual cramps. Her mother wanted her to see a gynecologist, but my patient was reluctant. At my office, we have a room that is dedicated to providing gynecologic care, including pelvic exams, that contains a proper exam table with stirrups. The patient, her mother, and I discussed reasons that some adolescents can have their gynecologic health managed in the pediatrician’s office and some teenagers get referred to gynecologists.
Many pediatricians can handle:
- Routine/annual gynecological exams, including a Pap test, in sexually active patients
- Vaginal/cervical cultures used to diagnose new conditions (some general pediatric offices are even equipped with a microscope to aid in their evaluations)
- Acute gynecologic concerns such as vaginal discharge, itching, or a change in menstrual flow
Reasons for a referral to a gynecologist include:
- The patient has pelvic pain and needs further evaluation of her ovaries, fallopian tubes, or uterus
- Patient and pediatrician have failed to find a birth control pill that is acceptable (too many side effects or unacceptable side effects) and thus require expert opinion of a gynecologist regarding oral contraceptive pills
- The patient engages in high-risk sexual activity
- Pediatrician does not provide gynecologic services
- The patient becomes pregnant
This family opted to have me perform my patient’s first pelvic exam since I was familiar to her and this brought her some comfort.
Carly W. Wilbur, MD, FAAP
Suburban Pediatrics, Inc.
Rainbow Babies and Children’s Hospital
Cleveland, Ohio
© 2010 Two Peds in a Pod℠
Revised 9:15pm 10/25/10
Lately my office staff has taken to giving out Sillybandz as rewards for kids who bravely endure the sting of vaccines , cooperate during exams, or just behave well while along for the ride at a sibling’s doctor visit. The kids LOVE them. Better than stickers. Healthier than lollipops.
From an educational perspective, these glorified rubber bands can help demonstrate normal child behavior and development:
Toddlers explore their world by using all their senses. They will touch and pull on SillyBandz in imitation of their older siblings. But watch out, they also explore by mouthing objects…don’t let them choke on a band.
Preschool and young school aged children try to impose order to their world, learn rules, and then often follow rules to the extreme. This tendency explaines why primary school-aged kids count and sort their SillyBandz by color or category. They understand trading and bartering, and they apply their knowledge to SillyBandz. Starting now, they understand number value and assume that whoever has the most of something also has the most power. This explains their desire for more and more SillyBandz. Kids this age respond to the “here and now” in their environment. They have a poor concept of time. If you use the bracelets as positive incentives, give them one immediately as a reward. If you tell your four year old you will buy him SillyBandz next week as a reward, he will forget why you are rewarding him and he won’t be motivated to repeat the good behavior you desire.
Middle school kids love to form clubs. Peers become more important than family. Wearing a particular set of SillyBandz makes them feel as if they belong to a club. This mentality is also the reason kids may wear unmatching socks- it puts them in the same club as their friends who also follow the identical fad. Other kids this age may balk entirely at the notion of SillyBandz (“they’re stupid” or “they’re for babies”) in an effort to avoid being like their younger siblings who are obsessed with SillyBandz.
Teenagers wear them when they believe that everyone else does. They are not so concerned about counting, ordering, or obtaining the most of something. Like the middle school kids, they are concerned about fitting in. Because this is an implusive age as well as an age of moral development, the same teen may buy a hundred SillyBandz but then give them all away. With teens, choose your battles. Put your foot down about things such as drugs and poor school performance. However, if your teen feels like wearing SillyBandz to the prom, express your displeasure, if you must, but let her go.
We grown-ups simply take advantage of the popularity of SillyBandz and use them to reward our children for good behavior, for completing homework in a timely manner and without arguments, for getting a good grade, for remembering to brush teeth every day for a week without parental reminders, and on and on.
Or we can just wear them too. Wonder if that would kill their appeal for kids.
Julie Kardos, MD with Naline Lai, MD
©2010 Two Peds in a Pod
Now, if you missed the piece on the air today, you can always listen to it Here: Two Peds in a Pod NPR Story.
Julie Kardos, MD and Naline Lai, MD
©2010 Two Peds in a Pod®
You poured out all of your two liter soda bottles, replaced all the potato chip snacks with fruit and signed all your children up for winter sports. Just when you thought your family’s activity and diet balance was perfect, along comes Halloween, that fabulous candy-filled holiday to thwart your efforts. Ways to keep the candy deluge down to a trickle:
-Let your children know Halloween (and most holidays) lasts only one day. Live it up on Halloween then dump the extra sweets into the trashcan the next day.
-Buy back the candy with toys or money. Alternatively, have the sweet tooth fairy come overnight, pick up the candy and leave a present behind.
-If you decide to keep a small bag of candy around, watch out, your children will be tempted to eat some daily. Candy becomes an ongoing “must have.” Instead, designate a day to eat candy during the week such as Sweet Saturday or Candy Friday. If the kids whine for candy on any other day of the week, you can say, ”Sorry, it’s not Sweet Saturday.”
-One parent told me she discourages her kids from eating Halloween candy by making their dental appointments on November 1—the day after Halloween.
According to an article published in the New England Journal of Medicine in 2000, the average American adult gains about a pound over the winter holidays. Unfortunately, the weight is not shed during the rest of the year.
Hope your kids don’t grow into that kind of adult. Now, that’s a scary Halloween thought.
Naline Lai, MD with Julie Kardos, MD
©2010 Two Peds in a Pod
Parents can become frustrated when searching for effective therapeutic treatment for childhood anxiety. Parents want to know what works and what their child will experience. Cognitive behavioral therapy is one type of therapy for children which directly addresses the behaviors kids exhibit. When anxiety starts, CBT gives kids concrete strategies to employ. Today psychologist and mom, Dr. Leah Murphy gives us an example of cognitive behavioral therapy treatment and how it involves the patient’s family and community.
Naline Lai, MD and Julie Kardos, MD
We all experience anxiety at times; anxiety can help us get things done (e.g., study for a test, finish a project, complete things in time for deadlines) and inform us that something is wrong. However, frequent, moderate to high levels of childhood anxiety both prevent, and interfere with, enjoyment and success in the school, home, and social arenas, resulting in a poorer quality of life. Wanting to improve your child’s anxiety and stress without “pushing them” much? You could have a look about at what summer activities for kids might be able to help manage their anxieties.
The experience of Connor, an 11 year-old boy, is a good example of how children can experience and show social and separation anxiety, as well as of how psychologists help children with anxiety.
Connor constantly worried. When he came to school Connor clung to his mother. At bedtime, Connor was unable to fall asleep without a parent staying with him, and he would often wake up and go into his parents’ room in the middle of the night. He even felt uncomfortable talking to other children. He constantly worried that kids would not like him and that he would “do something” that would cause the other children to tease him. He would avoid other children, and as a result, he had very few friends. He felt sad and lonely. Connor’s social and separation anxiety also manifested in physical symptoms. He felt nauseous, tired, suffered headaches and stomach aches, and experienced panic attacks in social situations. At school, Connor failed to concentrate on his work. Anger ensued when he felt pressure to perform anxiety provoking acts.
To help Conner, his pediatrician determined Conner had anxiety but no other medical condition and referred Conner to us for therapy. Our initial therapy sessions focused on teaching him how to to identify and express his feelings. During these sessions he created a feelings dictionary book and a feelings collage.
During the next set of sessions, Connor learned relaxation skills (deep breathing and muscle relaxation), positive coping thinking (“I can do this, the chance of something bad happening is very small, the chance of something good happening is very big”), and problem solving skills to help him to identify and implement solutions to the problems that made him nervous. Most sessions were conducted individually, but his parents participated in these sessions at times to learn the skills and to establish a plan for practicing and using these skills outside of our sessions. Also, I conducted parent-only and family meetings helped his parents cope with their own stress and anxiety about Connor’s difficulties.
During the last part of the skills based therapy, Connor used his skills in the situations which made him anxious. Starting with the least anxiety provoking situations, he gradually worked into more anxiety provoking situations. He practiced asking a teacher for a pencil, asking a waiter for a napkin/straw, introducing himself to a new peer, giving answers in class, asking a teacher for help, and going to swim lessons/baseball. We made a list of coping strategies (think positive, deep breathing, muscle relaxation, use problem solving steps, ask an adult for support/help) that he could use when overcoming anxiety provoking situations. He hung this list in his room and sometimes took it with him in his pocket or backpack. Apparently it was a lot of help to him.
Connor’s parents and school/camp staff prompted and reinforced his use of these skills in anxiety provoking situations. Connor had a point chart in which he earned points for using his skills and doing anxiety provoking activities. When he earned a sufficient number of points, he would pick a privilege from the privilege list that he created with his parents. Parent-only meetings during this time further assisted his parents cope with the discomfort and distress that they experienced when Connor began engaging in situations that caused him anxiety.
Additionally, Connor participated in a social skills group for children experiencing anxiety. Therapy groups are a great way for children to practice social skills while in a small group setting under supervision. The group practiced relaxation skills, as well as introduction/greeting and conversation skills. The group also learned skills to make friends.
In response to the therapy, all of Connor’s anxiety symptoms stopped over the course of 9-12 months, and his mood changed from anxious and fearful to calm and happy much of the time. He successfully attended school, participated in camp and after school programs, participated in social and recreational activities with children, and established friendships.
Sometimes, other strategies are needed to alleviate anxiety, including medication. Your pediatrician is able to provide information about medication options.
Leah Murphy, Psy.D.
Center for Psychology and Counseling www.psychologyandcounseling.com
© 2010 Two Peds in a Pod
(introduction modified 10:48a.m. October 13, 2010)