More than 90% of children in the US are getting too much sodium in their daily diet, according to a recent study by the CDC. Store bought foods accounted for 65% of consumed sodium, the majority coming from the following foods: pizza, yeast bread and rolls, cold cuts/cured meats, salty snacks like chips, pretzels and popcorn and chicken nuggets and patties. Fast food and pizza restaurants accounted for 13%. School cafeteria food only accounted for 9%, in line with national guidelines aimed at reducing sodium in school lunches. Approximately 39% of sodium intake occurred during dinner, 29.5% at lunch and 16.4% at snacks.
Not mentioned in the study I read was sodium intake in beverages, both soda and sports drinks.
Doubtless to say, it is important to watch your child's sodium intake (we should be watching ours as parents, as well) in order to decrease long term risks of developing high blood pressure and heart disease in the future.
Be informed consumers and read packages when you shop. Also - be aware of the high sodium content in fast foods.
Monday, November 3, 2014
Monday, October 6, 2014
Influenza Vaccine 2014 - Information for Parents
As pediatricians, we strongly recommend that all children receive Influenza vaccine to prevent Influenza. Influenza (also known as the flu) is a virus that infects through the nose, throat, windpipe and lungs; the virus is highly contagious between people, as it is spread through respiratory secretions and transmitted by coughing, sneezing or talking. Typical symptoms include fever, chills, muscle aches, congestion, cough and runny nose and difficulty breathing. Some people who contract the flu will develop pneumonia and bronchitis, some needing hospitalization. Unfortunately, some people who contract the flu die each year. Over 100 children died as a result of Influenza last year.
The Influenza vaccine (flu vaccine) is recommended for everyone 6 months of age and older. Children under 9 years old require 2 doses of vaccine separated by four weeks if they have never received a flu vaccine before. There are two versions of the vaccine available for children: nasal and injectable. Both versions are quadrivalent, which means they are made from 4 different strains of the Influenza virus.
The nasal vaccine (FluMist) is recommended for healthy people between the ages of 2 and 49, and has the advantage of inducing a faster and possibly longer-acting immune response without requiring a shot. Recent studies indicate that children age 2-8 mount a better immune response to the nasal flu vaccine, so it is strongly recommended in that age group, as long as children do not have underlying lung disease. FluMist is made from inactivated live virus and is cultured in eggs. It is given as a nasal spray. Side effects include mild congestion and runny nose.
The injectable vaccine (known as a flu shot) is cultured in eggs as well, and the virus is then inactivated with the chemical formaldehyde. The flu shot can be used in any patients, and is the only form recommended for children 6 months to 2 years old, as well as elderly patients. Side effects from the flu shot include pain at the injection site, redness at the injection site, muscle aches or low grade fever.
Neither the FluMist or single dose vials of injectable Influenza vaccine contain Thimerosal.
Because the virus particles are completely inactivated, one cannot "get" flu from the flu vaccine.
The Influenza vaccine typically prevents about 70 of every 100 people who receive it from developing moderate to severe influenza infection. Protection levels vary year to year, depending on which Influenza viruses are circulating, and how closely matched the Influenza vaccine is to the circulating strains.
The Influenza vaccine (flu vaccine) is recommended for everyone 6 months of age and older. Children under 9 years old require 2 doses of vaccine separated by four weeks if they have never received a flu vaccine before. There are two versions of the vaccine available for children: nasal and injectable. Both versions are quadrivalent, which means they are made from 4 different strains of the Influenza virus.
The nasal vaccine (FluMist) is recommended for healthy people between the ages of 2 and 49, and has the advantage of inducing a faster and possibly longer-acting immune response without requiring a shot. Recent studies indicate that children age 2-8 mount a better immune response to the nasal flu vaccine, so it is strongly recommended in that age group, as long as children do not have underlying lung disease. FluMist is made from inactivated live virus and is cultured in eggs. It is given as a nasal spray. Side effects include mild congestion and runny nose.
The injectable vaccine (known as a flu shot) is cultured in eggs as well, and the virus is then inactivated with the chemical formaldehyde. The flu shot can be used in any patients, and is the only form recommended for children 6 months to 2 years old, as well as elderly patients. Side effects from the flu shot include pain at the injection site, redness at the injection site, muscle aches or low grade fever.
Neither the FluMist or single dose vials of injectable Influenza vaccine contain Thimerosal.
Because the virus particles are completely inactivated, one cannot "get" flu from the flu vaccine.
The Influenza vaccine typically prevents about 70 of every 100 people who receive it from developing moderate to severe influenza infection. Protection levels vary year to year, depending on which Influenza viruses are circulating, and how closely matched the Influenza vaccine is to the circulating strains.
Wednesday, October 1, 2014
Acute Neurologic Illness Associated with Enterovirus D-68 ..What's Going on in Colorado
The respiratory illness associated with Enterovirus D-68 has spread to many states at this point, and now a cluster of cases have been found in Colorado with limb weakness, possibly due to the same virus.
Starting in August, Colorado and the CDC have identified a cluster of children 1-18 years of age (median age of 10) with acute focal limb weakness. At this time, there have been 9 confirmed cases. Most of the children are in the Denver metropolitan area, and all of them have been hospitalized. Specific testing has been done, including CSF analysis via lumbar puncture looking for meningitis. None of the cases had bacteria or virus isolated from the CSF, though there were signs of inflammation present. Spinal MRI scans showed lesions in the grey matter of the spinal cord, and some had brainstem lesions on MRI as well. Most children report having a respiratory illness associated with fever in the two weeks prior to developing limb weakness. No cases have had Enterovirus D-68 in the spinal fluid, although 6 of 8 cases did have Enterovirus D-68 isolated from nasal specimens. Further testing is being done.
The CDC is working closely with Colorado, and they have posted a health advisory on their website at:
http://emergency.cdc.gov/HAN/han00370.asp
Starting in August, Colorado and the CDC have identified a cluster of children 1-18 years of age (median age of 10) with acute focal limb weakness. At this time, there have been 9 confirmed cases. Most of the children are in the Denver metropolitan area, and all of them have been hospitalized. Specific testing has been done, including CSF analysis via lumbar puncture looking for meningitis. None of the cases had bacteria or virus isolated from the CSF, though there were signs of inflammation present. Spinal MRI scans showed lesions in the grey matter of the spinal cord, and some had brainstem lesions on MRI as well. Most children report having a respiratory illness associated with fever in the two weeks prior to developing limb weakness. No cases have had Enterovirus D-68 in the spinal fluid, although 6 of 8 cases did have Enterovirus D-68 isolated from nasal specimens. Further testing is being done.
The CDC is working closely with Colorado, and they have posted a health advisory on their website at:
http://emergency.cdc.gov/HAN/han00370.asp
Monday, September 22, 2014
Concussion Diagnosis and Treatment in Children
Head injuries and resulting concussions affect many children and teenagers every year. A concussion is a type of traumatic brain injury from a direct blow to the head or from a transmitted force causing linear or rotational acceleration. The definition of concussion has evolved over the last decade, and loss of consciousness is no longer a criteria for the diagnosis. Children and adolescents with concussions experience, on average, 10-14 days of symptoms. Evidence suggests this may be longer in younger children.
Though organized sports are thought to be the primary arena for injuries, head injuries and concussions can happen from any recreational injury, even an injury first thought to be a minor one. High schools in many localities have undergone extensive training in order to recognize concussions in athletes. Concussion rates are highest in football (American football - not soccer), Boys' ice hockey and lacrosse, and Girls' soccer.
Many schools use an evaluation tool called IMPACT --this test is composed of a series of questions, as well as mental and reflex performance measures -- designed to pick up on key nuances and signs resulting from a head injury. Athletes are given a baseline test at the beginning of the school year, or the beginning of the sports season, and further tests are done after injuries. The scores are compared with one another to look for impairments. Medical professionals find the IMPACT test useful as one tool in determining whether athletes are mentally able to return to school activities or sports participation. Another tool that is useful is the SCAT3 (Sport Concussion Assessment Tool). The SCAT3 has one section called the Sideline Assessment, designed to evaluate an athlete right away at the time of injury, as well as a symptom checklist (completed by the child) with severity levels for each symptom, a cognitive and memory assessment, and a physical balance and coordination test. Again, this test is useful when performed multiple times in an assessment of a child who has had a concussion.
Common symptoms of traumatic brain injury and concussions include:
Physical symptoms - dizziness, problems with balance, headache, nausea/vomiting, sensitivity to light or noise, visual problems
Cognitive symptoms - change in school performance, difficulty paying attention or concentrating, difficulty remembering, feeling confused about recent events, feeling foggy/"in a daze", forgetfulness, slowed response times
Emotional symptoms - irritability, increased emotions/moodiness, sadness, nervousness or anxiety, loss of interest in activities
Sleep/energy symptoms - drowsiness, fatigue, sleeping more than usual or insomnia/difficulty falling asleep
Following an initial evaluation, your medical provider will likely talk about putting your child on "cognitive rest" for a minimum of 5 days. This means absence from school and associated school work, as well as no sports or physical activity, no TV/computer/texting/video games/driving. When symptoms improve, a gradual return to activity can be coordinated. It is important to realize that the cognitive symptoms may remain even after the initial physical symptoms go away. Close coordination with medical providers, school personnel, trainers and coaches is important to give a child a good environment in which they can return to full functioning.
Though organized sports are thought to be the primary arena for injuries, head injuries and concussions can happen from any recreational injury, even an injury first thought to be a minor one. High schools in many localities have undergone extensive training in order to recognize concussions in athletes. Concussion rates are highest in football (American football - not soccer), Boys' ice hockey and lacrosse, and Girls' soccer.
Many schools use an evaluation tool called IMPACT --this test is composed of a series of questions, as well as mental and reflex performance measures -- designed to pick up on key nuances and signs resulting from a head injury. Athletes are given a baseline test at the beginning of the school year, or the beginning of the sports season, and further tests are done after injuries. The scores are compared with one another to look for impairments. Medical professionals find the IMPACT test useful as one tool in determining whether athletes are mentally able to return to school activities or sports participation. Another tool that is useful is the SCAT3 (Sport Concussion Assessment Tool). The SCAT3 has one section called the Sideline Assessment, designed to evaluate an athlete right away at the time of injury, as well as a symptom checklist (completed by the child) with severity levels for each symptom, a cognitive and memory assessment, and a physical balance and coordination test. Again, this test is useful when performed multiple times in an assessment of a child who has had a concussion.
Common symptoms of traumatic brain injury and concussions include:
Physical symptoms - dizziness, problems with balance, headache, nausea/vomiting, sensitivity to light or noise, visual problems
Cognitive symptoms - change in school performance, difficulty paying attention or concentrating, difficulty remembering, feeling confused about recent events, feeling foggy/"in a daze", forgetfulness, slowed response times
Emotional symptoms - irritability, increased emotions/moodiness, sadness, nervousness or anxiety, loss of interest in activities
Sleep/energy symptoms - drowsiness, fatigue, sleeping more than usual or insomnia/difficulty falling asleep
Following an initial evaluation, your medical provider will likely talk about putting your child on "cognitive rest" for a minimum of 5 days. This means absence from school and associated school work, as well as no sports or physical activity, no TV/computer/texting/video games/driving. When symptoms improve, a gradual return to activity can be coordinated. It is important to realize that the cognitive symptoms may remain even after the initial physical symptoms go away. Close coordination with medical providers, school personnel, trainers and coaches is important to give a child a good environment in which they can return to full functioning.
Wednesday, September 10, 2014
Enterovirus D68 - The New Respiratory Virus
A severe respiratory virus affecting children in Missouri and Illinois, and leading to a high rate of ER visits and hospitalization, has been identified as an Enterovirus and classified as Enterovirus D68. The CDC has a nice synopsis about EV-D68 on their website.
The Enterovirus family contains over one hundred viruses that typically circulate in the summer and fall, and usually cause gastroenteritis (stomach flu, vomiting and diarrhea). EV-D68 was first identified in California in 1962, and has rarely been reported in the US for the last 40 years. EV-D68 is unique in that it causes respiratory symptoms similar to common cold viruses as well.
Hospitals in Missouri and Illinois started seeing severe respiratory illness in school-age children earlier this month. At first, influenza was suspected, and due to the clustered nature of cases, cultures were sent to state and CDC laboratories. This is how the EV-D68 was identified.
The CDC is involved and is actively tracking cases and assisting affected states with testing. Regular hospital and commercial labs can isolate enterovirus from specimens, but cannot definitely type it as D68.
Symptoms: mild to severe respiratory illness characterized by cough and runny nose (typical cold symptoms) that can progress to difficulty breathing, wheezing and pneumonia-like symptoms
Transmission: EV-D68 is not frequently identified, so some questions exist as to the ways it would usually spread; however, since the virus is found in respiratory secretions (saliva, mucus, sputum) it may spread from person to person when an infected person coughs, sneezes or touches common contaminated surfaces. Since EV-D68 is an enterovirus, it may also spread by the fecal-oral route.
You can help protect yourself from respiratory illnesses by: washing your hands often with soap and water for at least 20 seconds, especially after changing diapers or helping children in the bathroom. Avoid touching your eyes, nose and mouth with unwashed hands, since viruses can exist on surfaces. Avoid sharing drinks, cups, eating utensils, washcloths and towels with people who are sick. Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone in the house is sick.
As with any other respiratory illness, if you or your children are sick, see a doctor if you have a high fever, difficulty breathing or lethargy. Monitor your children's breathing - if they seem short of breath, or are tiring and breathing fast, you should have them evaluated. Respiratory viruses can cause more severe infection in people who have underlying respiratory or lung diseases like asthma.
Update 9/17/14: The state health department in our state (VA) has confirmed that they are seeing confirmed cases here in Virginia. As in other states, children are presenting with respiratory symptoms similar to the common cold - runny nose, nasal congestion, cough and sometimes wheezing. As with many viruses that cause colds, symptoms can range from mild to more serious with difficulty breathing and wheezing noted. Fall weather, and the return of many children to the school setting, is usually associated with an increase in the spread of upper respiratory viruses.
Regular hygiene, good hand washing, and limiting your child's sick contacts (when possible) are important precautions to take.
There truly may be more widespread Enterovirus D-68 causing mild cold symptoms in children, in cases that would not prompt testing for specific viruses. As is usually the case, if your child develops difficulty breathing, or abruptly worsens during the course of an upper respiratory infection, they should be evaluated by their medical provider.
The Enterovirus family contains over one hundred viruses that typically circulate in the summer and fall, and usually cause gastroenteritis (stomach flu, vomiting and diarrhea). EV-D68 was first identified in California in 1962, and has rarely been reported in the US for the last 40 years. EV-D68 is unique in that it causes respiratory symptoms similar to common cold viruses as well.
Hospitals in Missouri and Illinois started seeing severe respiratory illness in school-age children earlier this month. At first, influenza was suspected, and due to the clustered nature of cases, cultures were sent to state and CDC laboratories. This is how the EV-D68 was identified.
The CDC is involved and is actively tracking cases and assisting affected states with testing. Regular hospital and commercial labs can isolate enterovirus from specimens, but cannot definitely type it as D68.
Symptoms: mild to severe respiratory illness characterized by cough and runny nose (typical cold symptoms) that can progress to difficulty breathing, wheezing and pneumonia-like symptoms
Transmission: EV-D68 is not frequently identified, so some questions exist as to the ways it would usually spread; however, since the virus is found in respiratory secretions (saliva, mucus, sputum) it may spread from person to person when an infected person coughs, sneezes or touches common contaminated surfaces. Since EV-D68 is an enterovirus, it may also spread by the fecal-oral route.
You can help protect yourself from respiratory illnesses by: washing your hands often with soap and water for at least 20 seconds, especially after changing diapers or helping children in the bathroom. Avoid touching your eyes, nose and mouth with unwashed hands, since viruses can exist on surfaces. Avoid sharing drinks, cups, eating utensils, washcloths and towels with people who are sick. Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone in the house is sick.
As with any other respiratory illness, if you or your children are sick, see a doctor if you have a high fever, difficulty breathing or lethargy. Monitor your children's breathing - if they seem short of breath, or are tiring and breathing fast, you should have them evaluated. Respiratory viruses can cause more severe infection in people who have underlying respiratory or lung diseases like asthma.
Update 9/17/14: The state health department in our state (VA) has confirmed that they are seeing confirmed cases here in Virginia. As in other states, children are presenting with respiratory symptoms similar to the common cold - runny nose, nasal congestion, cough and sometimes wheezing. As with many viruses that cause colds, symptoms can range from mild to more serious with difficulty breathing and wheezing noted. Fall weather, and the return of many children to the school setting, is usually associated with an increase in the spread of upper respiratory viruses.
Regular hygiene, good hand washing, and limiting your child's sick contacts (when possible) are important precautions to take.
There truly may be more widespread Enterovirus D-68 causing mild cold symptoms in children, in cases that would not prompt testing for specific viruses. As is usually the case, if your child develops difficulty breathing, or abruptly worsens during the course of an upper respiratory infection, they should be evaluated by their medical provider.
Thursday, July 10, 2014
Parenting Reviews Best Booster Seats
Parenting magazine recently reviewed the Insurance Institute for Highway Safety "best bets" for booster seats. I will include the link (below) and summarize some safety highlights for use when you are shopping for booster seats.
Most children are ready to switch from a 5-point restraint car seat to a booster seat at about 4 years old and once they have reached 40 lbs. All children are different, so some three year olds may be ready to switch if they have reached the weight limit of your current car seat. However, many restraint seats now have higher weight limits. If your child is still comfortable in one, there is no hard and fast rule saying that you need to switch.
You will need to decide between a high-back booster seat or a backless one. High-back boosters have shoulder belt routing guides, so they can position the shoulder belt more appropriately for your child. High-back models should also be your first choice if your backseat doesn't have a headrest. Backless boosters tend to be less expensive, and may have better lap belt placement.
If you shop in a big box store, most of the time you can try out a floor model. This is important, as seats can fit different children differently (for example, some seats are more narrow, and may be uncomfortable for your child).
The main goal of a booster seat is to elevate your child so that the adult seat belt fits well and protects your child in case of a car crash. The lap belt should fall across the upper thigh, not the abdomen. That way, the impact of a crash is absorbed across the pelvis and not across the soft tissue of the abdomen, which is more vulnerable to injury. The shoulder belt should fit snugly across the middle of the shoulder, not too close to the neck, but not lax enough to fall off the shoulder either.
Always check your child and the placement of shoulder and lap belts each time they get in the car, as the seats themselves can slide around in the backseat, away from the ideal location.
http://www.parenting.com/blogs/show-and-tell/more-booster-seats-earn-top-safety-ratings
Most children are ready to switch from a 5-point restraint car seat to a booster seat at about 4 years old and once they have reached 40 lbs. All children are different, so some three year olds may be ready to switch if they have reached the weight limit of your current car seat. However, many restraint seats now have higher weight limits. If your child is still comfortable in one, there is no hard and fast rule saying that you need to switch.
You will need to decide between a high-back booster seat or a backless one. High-back boosters have shoulder belt routing guides, so they can position the shoulder belt more appropriately for your child. High-back models should also be your first choice if your backseat doesn't have a headrest. Backless boosters tend to be less expensive, and may have better lap belt placement.
If you shop in a big box store, most of the time you can try out a floor model. This is important, as seats can fit different children differently (for example, some seats are more narrow, and may be uncomfortable for your child).
The main goal of a booster seat is to elevate your child so that the adult seat belt fits well and protects your child in case of a car crash. The lap belt should fall across the upper thigh, not the abdomen. That way, the impact of a crash is absorbed across the pelvis and not across the soft tissue of the abdomen, which is more vulnerable to injury. The shoulder belt should fit snugly across the middle of the shoulder, not too close to the neck, but not lax enough to fall off the shoulder either.
Always check your child and the placement of shoulder and lap belts each time they get in the car, as the seats themselves can slide around in the backseat, away from the ideal location.
http://www.parenting.com/blogs/show-and-tell/more-booster-seats-earn-top-safety-ratings
Wednesday, April 23, 2014
It's Allergy Season Again!
I covered medical treatment of allergies in March of 2012, and wanted to briefly go over some important points for seasonal allergy sufferers. Spring time allergies arrive with the warmer weather, growing grass, and the pollen that is produced from those lovely newly budding trees. For many people, typical symptoms of season allergic rhinitis start in Springtime also.
Tips for allergy symptoms:
1. If you take medications for allergies, you may need to start treatment 2 weeks before your symptoms usually start. Antihistamines sometimes take that long to show a benefit.
2. Check pollen counts before going outside - you can find this information on line at aaaai.org/nab. If counts are high, limit your time outside and take your allergy medication.
3. No matter how tempting, you may need to keep your windows shut - at home and in the car, to minimize your exposure to airborne pollens.
4. Move outdoor activities to the afternoon - pollen counts are usually highest between 5-10 am. Wear a mask if you are working outside especially if you are mowing grass.
5. Plan outside activities on rainy days, or days in which it has rained, since moisture helps clear pollen from the air.
6. Discard your outside clothing and bathe or shower after you have spent a lot of times outdoors during allergy season.
7. Use HEPA filters in your house, and change them often.
8. Discuss medications with your doctor - some medications can cause elevated blood pressure and insomnia (Sudafed derivatives) or can make you sleepy (older antihistamines like Benadryl).
9. Consider using saline nasal spray or a Neti pot to flush your nasal passages.
Tips for allergy symptoms:
1. If you take medications for allergies, you may need to start treatment 2 weeks before your symptoms usually start. Antihistamines sometimes take that long to show a benefit.
2. Check pollen counts before going outside - you can find this information on line at aaaai.org/nab. If counts are high, limit your time outside and take your allergy medication.
3. No matter how tempting, you may need to keep your windows shut - at home and in the car, to minimize your exposure to airborne pollens.
4. Move outdoor activities to the afternoon - pollen counts are usually highest between 5-10 am. Wear a mask if you are working outside especially if you are mowing grass.
5. Plan outside activities on rainy days, or days in which it has rained, since moisture helps clear pollen from the air.
6. Discard your outside clothing and bathe or shower after you have spent a lot of times outdoors during allergy season.
7. Use HEPA filters in your house, and change them often.
8. Discuss medications with your doctor - some medications can cause elevated blood pressure and insomnia (Sudafed derivatives) or can make you sleepy (older antihistamines like Benadryl).
9. Consider using saline nasal spray or a Neti pot to flush your nasal passages.
Wednesday, February 19, 2014
A Parent's Guide To Napping
When I see babies and young children for well visits, I get many questions about sleep and napping needs. A newborn enters the world sleeping about 20 hours in a 24 hour period. Basically, this means they are usually awake to eat, then fade back to sleep again after eating. As your infant grows, they are able to have longer "awake and alert" periods as their bodies adapt to the daylight and darkness of a diurnal schedule. Sleep is important to both babies and children for many reasons. Growth hormone is mainly produced during sleep, and the immune system benefits from regular sleep intervals. During sleep, the brain processes information important in the development of memory and organizes the data that children absorb in the hours that they are awake. Regular sleep aids development, according to sleep coach Kim West, who has written a book, "The Sleep Lady's Good Night, Sleep Tight: Gentle Proven Solutions to Help Your Child Sleep Well and Wake Up Happy". Sleep deprivation, on the other hand, is linked in many studies to an increased risk of obesity. Babies who sleep fewer than 12 hours total per day have double the risk of being overweight for their age.
Sleep and nap needs vary by age. For the first two months of life, an infant will sleep 18-20 hours per day, with 3-4 naps per day totaling 6-7 hours. Between 2 and 6 months, napping intervals decrease to 3 naps per day for about 5 hours. Younger infants generally will wake every 3 hours or so to eat, but by 3-4 months of age, they are able to space out feedings and can often sleep for a longer stretch of 5-6 hours at night.
Tips for this age: limit "on the go" napping and try to establish a routine of putting your child down for a nap in a dark, quiet room in a crib or bassinet. Do this at least twice a day at regular intervals.
For older infants, 6-12 months old, a transition occurs in which they usually establish a routine of 2-3 naps a day for a total of 3 hours or so. These "big naps" should be 60-90 minutes each. This is a good age to start a bedtime and pre-nap routine for your child. Nap time should still occur in a dark, quiet place. Children at this age need to acquire the skills to be able to calm themselves to sleep, so it is important to put them in the crib when they are still awake (putting them down sleepy is ok, putting them down asleep is not).
For 12-18 month olds, naps usually occur twice a day for a total of two to two and a half hours. By 18 months, many children are ready to transition to one nap a day in the afternoon. Look for clues at 15-18 months that your child may be ready to do this: taking longer to fall asleep in the morning or taking a long nap in the morning and not being able to fall asleep in the afternoon. You can help make the switch by gradually pushing the morning nap time later and later by 30 minute intervals until you end up with the nap occurring after lunch. Once you get to this point, your child will probably sleep for a good 2-3 hours.
By age 3, most children have shortened the afternoon nap to 60-90 minutes. If your child is resistant to napping, it is important to offer "quiet time" for an hour in the afternoon. Some children won't sleep every day, but it important for them to have designated time to do so. Your child's brain is wired to recognize a missed nap by stimulating the production of cortisol, our body's "stress hormone". This is why some kids seem "wired" on days that they miss naps!
By age 4-5, most children have given up afternoon napping, though may still do well with quiet time/optional nap time in the afternoon. It is important to not let preschoolers nap too long or too late, as this may interfere with night time sleep. There should be at least 4-5 hours between when your child wakes up from their nap and bedtime.
Having a regular routine for napping, and allowing your child the time they need to "practice" this skill, are both important parts of establishing nutritive sleep.
Sleep and nap needs vary by age. For the first two months of life, an infant will sleep 18-20 hours per day, with 3-4 naps per day totaling 6-7 hours. Between 2 and 6 months, napping intervals decrease to 3 naps per day for about 5 hours. Younger infants generally will wake every 3 hours or so to eat, but by 3-4 months of age, they are able to space out feedings and can often sleep for a longer stretch of 5-6 hours at night.
Tips for this age: limit "on the go" napping and try to establish a routine of putting your child down for a nap in a dark, quiet room in a crib or bassinet. Do this at least twice a day at regular intervals.
For older infants, 6-12 months old, a transition occurs in which they usually establish a routine of 2-3 naps a day for a total of 3 hours or so. These "big naps" should be 60-90 minutes each. This is a good age to start a bedtime and pre-nap routine for your child. Nap time should still occur in a dark, quiet place. Children at this age need to acquire the skills to be able to calm themselves to sleep, so it is important to put them in the crib when they are still awake (putting them down sleepy is ok, putting them down asleep is not).
For 12-18 month olds, naps usually occur twice a day for a total of two to two and a half hours. By 18 months, many children are ready to transition to one nap a day in the afternoon. Look for clues at 15-18 months that your child may be ready to do this: taking longer to fall asleep in the morning or taking a long nap in the morning and not being able to fall asleep in the afternoon. You can help make the switch by gradually pushing the morning nap time later and later by 30 minute intervals until you end up with the nap occurring after lunch. Once you get to this point, your child will probably sleep for a good 2-3 hours.
By age 3, most children have shortened the afternoon nap to 60-90 minutes. If your child is resistant to napping, it is important to offer "quiet time" for an hour in the afternoon. Some children won't sleep every day, but it important for them to have designated time to do so. Your child's brain is wired to recognize a missed nap by stimulating the production of cortisol, our body's "stress hormone". This is why some kids seem "wired" on days that they miss naps!
By age 4-5, most children have given up afternoon napping, though may still do well with quiet time/optional nap time in the afternoon. It is important to not let preschoolers nap too long or too late, as this may interfere with night time sleep. There should be at least 4-5 hours between when your child wakes up from their nap and bedtime.
Having a regular routine for napping, and allowing your child the time they need to "practice" this skill, are both important parts of establishing nutritive sleep.
Tuesday, January 7, 2014
Cyber Bullying - A Growing Issue for Teens
Social media has become an essential way that we communicate with each other these days. Over 80% of teenagers use a cell phone regularly, with ever growing access to "social" networking sites like Facebook, Instagram and Twitter. Texting others is commonplace, and some teens log multiple hours a day on their phones.
The concept of bullying is one that many schools have attempted to meet head on, but social media access has spawned a wave of online taunting and harassment now referred to as "Cyber bullying". Cyber bullying specifically refers to one individual (or sometimes, multiple people) tormenting, harassing or humiliating someone else through digital technology. Cyber bullying is usually not anonymous, as 75% of victims know the person behind the attack. Nearly 43% of kids have been bullied online. 25% have had it happen more than once. Bullying victims are 2 to 9 times more likely to consider committing suicide. If you read news regularly on the internet, you know how pervasive the problem is. If you have children and teenagers, you know how scary these statistics are.
Cyber bullying takes many forms - a bully may pretend to be someone else in order to obtain personal information from the victim, may pretend to be their victim in online communication with others or may post unflattering photos/videos or verbal insults about the victim. Unlike face to face bullying that occurs in the school setting, online attacks persist -- comments remain once posted on the internet, and essentially may be viewed by the entire world. Girls are twice as likely to be victims of online bullying, AND also nearly twice as likely to engage in bullying behavior themselves.
Unfortunately, teenagers who are harassed via social media often do not report these events to a parent. A study I read recently stated that only 10% of teens report cyber bullying to their parents or a trusted adult.
If our teenagers don't tell us about this, how do we know what is going on? Parents should be suspicious if their child suddenly changes their social media habits, appears upset or withdrawn after being online or avoids or becomes upset at social situations they previously enjoyed. In your presence, your teen may abruptly become upset after seeing a cell phone text, or may state that they are blocking certain callers or numbers. Unfortunately, in my practice I have seen many teens who "can't help themselves" and continue to read or obsess about things that are posted about them online. I have had many parents take phones and computer access away from their children in an attempt to deal with cyber bullying.
If your teen hasn't been bullied before, they likely know someone who has -- bringing up the topic may allow you to start talking about the potential issues before they happen. Consider it as essential as discussing safe sex, drugs and alcohol with your teen.
Parents should actively monitor their children's online media use through practices like checking out their homepage or viewing password-protected areas, particularly with younger children. Teens often want privacy in their online forums, so there may have to be a discussion about what you as a parent will be doing, or will want to see. Make sure your children do not give out their passwords to others.
For children who experience cyber bullying, mental health experts recommend the following:
1. Avoid responding or retaliating directly with the bully, as this may reinforce the behavior
2. Block the bully's message or delete them without reading them
3. Work with parents to notify the media sites involved, as the service providers can internally address any bullying issues
4. Consider working with you local school system to extend their bully education campaigns to address cyber bullying as well
5. Change passwords if necessary, and do not share passwords or keep passwords in a place easily accessed by others
6. Consider keeping a log of the bullying events - this may be useful if law enforcement gets involved
Some useful online resources:
www.stopbullying.gov
www.stopcyberbullying.org
www.ncpc.org
Addendum 9/11/14:
I just saw a blurb in USA Weekend magazine quoting Janell Burley Hofmann, who wrote a book entitled "IRules: What Every Tech-Healthy Family Needs to Know about Selfies, Sexting, Gaming and Growing Up". I liked her idea about setting up rules "IRules" before giving your child a cell phone. Among them,
1. It is my phone. I bought it. I pay for it. I an loaning it to you. Aren't I the greatest?
2. I will always know the password.
3. Hand the phone to one of your parents at 7:30 pm every school night and every weekend night at 9:00 pm. It will be shut off for the night and turned on again at 7:30 am.
Couldn't agree more :)
The concept of bullying is one that many schools have attempted to meet head on, but social media access has spawned a wave of online taunting and harassment now referred to as "Cyber bullying". Cyber bullying specifically refers to one individual (or sometimes, multiple people) tormenting, harassing or humiliating someone else through digital technology. Cyber bullying is usually not anonymous, as 75% of victims know the person behind the attack. Nearly 43% of kids have been bullied online. 25% have had it happen more than once. Bullying victims are 2 to 9 times more likely to consider committing suicide. If you read news regularly on the internet, you know how pervasive the problem is. If you have children and teenagers, you know how scary these statistics are.
Cyber bullying takes many forms - a bully may pretend to be someone else in order to obtain personal information from the victim, may pretend to be their victim in online communication with others or may post unflattering photos/videos or verbal insults about the victim. Unlike face to face bullying that occurs in the school setting, online attacks persist -- comments remain once posted on the internet, and essentially may be viewed by the entire world. Girls are twice as likely to be victims of online bullying, AND also nearly twice as likely to engage in bullying behavior themselves.
Unfortunately, teenagers who are harassed via social media often do not report these events to a parent. A study I read recently stated that only 10% of teens report cyber bullying to their parents or a trusted adult.
If our teenagers don't tell us about this, how do we know what is going on? Parents should be suspicious if their child suddenly changes their social media habits, appears upset or withdrawn after being online or avoids or becomes upset at social situations they previously enjoyed. In your presence, your teen may abruptly become upset after seeing a cell phone text, or may state that they are blocking certain callers or numbers. Unfortunately, in my practice I have seen many teens who "can't help themselves" and continue to read or obsess about things that are posted about them online. I have had many parents take phones and computer access away from their children in an attempt to deal with cyber bullying.
If your teen hasn't been bullied before, they likely know someone who has -- bringing up the topic may allow you to start talking about the potential issues before they happen. Consider it as essential as discussing safe sex, drugs and alcohol with your teen.
Parents should actively monitor their children's online media use through practices like checking out their homepage or viewing password-protected areas, particularly with younger children. Teens often want privacy in their online forums, so there may have to be a discussion about what you as a parent will be doing, or will want to see. Make sure your children do not give out their passwords to others.
For children who experience cyber bullying, mental health experts recommend the following:
1. Avoid responding or retaliating directly with the bully, as this may reinforce the behavior
2. Block the bully's message or delete them without reading them
3. Work with parents to notify the media sites involved, as the service providers can internally address any bullying issues
4. Consider working with you local school system to extend their bully education campaigns to address cyber bullying as well
5. Change passwords if necessary, and do not share passwords or keep passwords in a place easily accessed by others
6. Consider keeping a log of the bullying events - this may be useful if law enforcement gets involved
Some useful online resources:
www.stopbullying.gov
www.stopcyberbullying.org
www.ncpc.org
Addendum 9/11/14:
I just saw a blurb in USA Weekend magazine quoting Janell Burley Hofmann, who wrote a book entitled "IRules: What Every Tech-Healthy Family Needs to Know about Selfies, Sexting, Gaming and Growing Up". I liked her idea about setting up rules "IRules" before giving your child a cell phone. Among them,
1. It is my phone. I bought it. I pay for it. I an loaning it to you. Aren't I the greatest?
2. I will always know the password.
3. Hand the phone to one of your parents at 7:30 pm every school night and every weekend night at 9:00 pm. It will be shut off for the night and turned on again at 7:30 am.
Couldn't agree more :)
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