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Slide 1: Children RSV When It’s More Than a Cold Healthy American Academy of Pediatrics Winter 2008 Positive Parenting Encouraging Good Behavior Good Reasons to Smile Healthy Teeth for a Healthy Life Adolescent Sexuality How to Have “the Talk” — and Keep Talking Waiting Room Copy Sponsored by
Slide 2: Looking Back, Looking Ahead Welcome to a new year of Healthy Children. This issue begins our second year of publication. It’s been a big year for our magazine and we have much to celebrate! Your feedback continues to be overwhelmingly positive and insightful. Thank you for sharing your thoughts. And the publishing industry seems to agree, as Healthy Children won two prestigious awards this fall from Folio magazine (the magazine industry) and the Health Information Resource Center (consumer health information). We are delighted and honored to be recognized for the quality of our publication. In our winter issue, you’ll find more of the award-winning content you can rely on for your family. We’ll tell you what you need to know about respiratory syncytial virus, or RSV (page 8), winter sports safety (page 12), oral health (page 16), positive parenting (page 22), and adolescent sexuality (page 24), to name a few topics. As we move into our second year of publishing, we will work even harder to provide reliable parenting information. That means keeping you up to date on the latest research and news, providing timely and insightful features, and sharing expert guidance to help you make the best decisions in caring for your children. Pediatricians take their obligation to our nation’s children very seriously. As the new AAP president, I hope to lead a renewed effort at making the well being of our children — especially those who have been overlooked because of poverty or other factors — a priority not just for our organization, but also for our nation as a whole. We can and must do better for all American children, no matter who they are or where they live. In short, you can expect Healthy Children — the magazine from the nation’s largest and most trusted professional association of pediatricians — to continue to put children’s health and wellness first. Renée R. Jenkins, M.D., FAAP President, American Academy of Pediatrics 2 Healthy Children Winter 2008
Slide 3: American Academy of Pediatrics Children 2 American Academy of Pediatrics attn: Healthy Children Magazine 141 Northwest Point Blvd. Elk Grove Village, IL 60007 healthychildren@aap.org AAP Editorial Advisory Board Tanya Remer Altmann, MD, FAAP Westlake Village, CA Laura A. Jana, MD, FAAP Omaha, NE Jennifer Shu, MD, FAAP Atlanta, GA Robert W. Steele, MD, FAAP Springfield, MO Paul R. Stricker, MD, FAAP San Diego, CA Healthy Winter 2008 Welcome Dr. Renée Jenkins, AAP president, welcomes you to AAP’s authoritative resource for parents. 3 4 6 8 Table of Contents This Just In … The latest parenting news, research, and health tips from our experts Ask the Pediatrician Answers to common questions RSV: When It’s More Than Just a Cold Sometimes those “cold symptoms” aren’t symptoms of a cold, but of another type of infection — RSV. Learn more about this virus and how to keep it at bay. 12 American Academy of Pediatrics Executive Director Errol R. Alden, MD, FAAP Associate Executive Director Roger F. Suchyta, MD, FAAP Director, Department of Marketing and Publications Maureen DeRosa, MPA Director, Division of Product Development Mark Grimes Manager, Consumer Publishing Carolyn Kolbaba Manager, Patient Education Regina Moi Martinez Coordinator, Product Development Holly Kaminski Manager, Consumer Product Marketing and Sales Kathleen Juhl Chillin’ with Safety As children stay active during the cold winter months, remember that safety should be just as much of a priority as when the weather warms up. 16 Good Reasons to Smile Good oral health is an important part of good overall health. Here’s what you need to know to start your children on the path of dental care while they’re young. 20 22 Fever Without Fear Fever can signal a number of possibilities about a child’s health. When is it time to call the doctor? Positive Parenting: How to Encourage Good Behavior You can be firm, gentle, and loving with your children while encouraging their best behavior. Here are some real-life tips on how to do just that. For advertising information, please contact: Cindy Reed Vitality Communications (336) 547-8970, ext. 3355 Healthy Children is published by Vitality Communications 407 Norwalk St., Greensboro, NC 27407 | (336) 547-8970 24 Adolescent Sexuality: Talk the Talk Before They Walk the Walk Is there a more awkward teen topic than sexuality? Just because it’s uncomfortable doesn’t mean it’s a conversation you can, or should, avoid. Here’s how to start the conversation and keep it going as your child matures. Managing Editors. . . . . . . . . . . . . . . . . . . . . . . . . . . Sam Gaines, Selby Bateman Creative Director . . . . . . . . . . . . . . . . . . . . . . . . . . . Jan McLean Production Director . . . . . . . . . . . . . . . . . . . . . . . . . Traci Marsh President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . William G. Moore Controller. . . . . . . . . . . . . . . . . . . . . . . . . . . Pat Blake Administrative Assistant . . . . . . . . . . . . . . . . . . . Pat Schrader © Copyright 2008 by the American Academy of Pediatrics. No part of this publication may be reproduced or transmitted in any form or by any means without written permission from the American Academy of Pediatrics. Articles in this publication are written by professional journalists who strive to present reliable, up-to-date health information. However, personal decisions regarding health, finance, exercise and other matters should be made only after consultation with the reader’s physician or professional adviser. All editorial rights reserved. Opinions expressed herein are not necessarily those of the American Academy of Pediatrics. Models are used for illustrative purposes only. The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Publication of an advertisement in Healthy Children neither constitutes nor implies a guarantee or endorsement by Healthy Children or the American Academy of Pediatrics of the product or service advertised or of the claims made for the product or service by the advertiser. 27 Winter Blues Sometimes depression follows a seasonal pattern. How can you tell the difference between depression and seasonal affective disorder (SAD)? Can it affect your child? Find out here. The American Academy of Pediatrics would like to thank for its sponsorship of this issue of Healthy Children. Healthy Children Winter 2008 3
Slide 4: This Just In... The latest parenting news, research, and health tips from our experts Cold Shoulder to Cold Medicines Following warnings from the U.S. Food and Drug Administration (FDA) and other federal agencies about the safety of over-the-counter (OTC) cough and cold products for children, leading drug companies voluntarily withdrew 14 infant oral medicines in October. Questions have been raised about the safety of these products and whether the benefits justify the potential risks they pose, especially in children younger than 2 years of age. The move does not apply to medicines intended for children older than 2. An OTC cough and cold medicine can be harmful if a child is given more than the recommended amount, given the medicine too often, or given more than one cough and cold medicine containing the same active ingredient. To avoid giving a child too much medicine, parents should carefully follow the directions and read the “Drug Facts” box on the package label. According to the American Academy of Pediatrics, several studies indicate that these products are not effective in children younger than 6 and can have potentially serious side effects, even when given as directed. Further, dosage guidelines for cold and cold mixtures are based on adult data and thus may be inaccurate for children. The following are a few things parents should know about using cough and cold products. (For a complete list, visit www.aap.org/new/ kidcolds.htm) Do not give cough and cold products to children younger than 2 years old unless your healthcare provider specifically directs you to. Do not give children medicine that is packaged and made for adults. Use only products marked for use in babies, infants or children (sometimes labelled “for pediatric use”). If your child is taking other OTC or prescription medicines, make sure your healthcare provider reviews and approves their combined use. Read and follow the directions in the “Drug Facts” box. Do not give a child medicine more often or in greater amounts than is stated on the package. Be sure you know the active ingredients and warnings. For liquid products, use the measuring device (dropper, dosing cup, or dosing spoon) that is packaged with each different medicine and is marked to deliver the recommended dose. A kitchen teaspoon or tablespoon is NOT an appropriate measuring device for giving medicines to children. If a child’s condition worsens or does not improve, stop using the product and immediately take the child to a healthcare provider for evaluation. The infant cough and cold medicines that have been withdrawn are: Dimetapp Decongestant Plus Cough Infant Drops Dimetapp Decongestant Infant Drops Little Colds Decongestant Plus Cough Little Colds Multi-Symptom Cold Formula Pediacare Infant Drops Decongestant (containing pseudoephedrine) Pediacare Infant Drops Decongestant & Cough (containing pseudoephedrine) Pediacare Infant Dropper Decongestant (containing phenylephrine) Pediacare Infant Dropper Long-Acting Cough Pediacare Infant Dropper Decongestant & Cough (containing phenylephrine) Robitussin Infant Cough DM Drops Triaminic Infant & Toddler Thin Strips Decongestant Triaminic Infant & Toddler Thin Strips® Decongestant Plus Cough Tylenol Concentrated Infants’ Drops Plus Cold Tylenol Concentrated Infants’ Drops Plus Cold & Cough 4 Healthy Children Winter 2008
Slide 5: New Nasal Flu Vaccine for Toddlers The U.S. Food and Drug Administration (FDA) recently approved expanded use of the nasal influenza vaccine FluMist in healthy people between the ages of 2 and 49 who are not pregnant. Previously the vaccine, which is sprayed in the nose, was limited to healthy children 5 years of age and older and to adults up to age 49. “The goal of preventing influenza is now more attainable with the availability of FluMist for younger children,” said Jesse L. Goodman, M.D., director, FDA’s Center for Biologics Evaluation and Research. “This approval also offers parents and health professionals a needle-free option for squeamish toddlers, who may be reluctant to get a traditional influenza shot.” FluMist should not be administered to anyone with asthma or to children younger than age of 5 years who experience recurrent wheezing because of the potential for increased wheezing after receiving the vaccine. Children allergic to any of FluMist’s components, including eggs or egg products, should also not receive the vaccine. Youth Suicide Rates Increase The suicide rate among young people ages 10 to 24 rose 8 percent from 2003 to 2004, marking the largest single-year increase in more than 15 years, according to a report recently released in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report (MMWR). During the 12-month period, suicide rates rose from 6.78 to 7.32 per 100,000. This increase follows a decline of more than 28 percent between 1990 and 2003, when rates fell from 9.48 to 6.78, the report stated. “We don’t yet know if this is a short-lived increase or if it’s the beginning of a trend,” said Ileana Arias, M.D., director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC). “Either way, it’s a harsh reminder that suicide and suicide attempts are affecting too many youth and young adults. We need to make sure suicide prevention efforts are continuous and reaching children and young adults.” The analysis also found that changes had taken place in the methods used to attempt suicide. In 1990, firearms were the most common method for both girls and boys. In 2004, however, hanging/suffocation was the most common suicide method among girls, accounting for 71.4 percent of suicides among 10- to 14-year-old girls and 49 percent among 15- to 19-year-old young women. From 2003 to 2004, there was a 119 percent increase in hanging/ suffocation suicides among 10- to 14-year-old girls. For boys and young men, firearms are still the most common method. For more information, visit www.cdc.gov/ncipc/ dvp/Suicide/youthsuicide.htm or www.cdc.gov/injury. The National Suicide Prevention Lifeline also provides resources for preventing suicide. Call 800-273-8255. Flu Fight Influenza is responsible for about 36,000 deaths and more than 200,000 hospitalizations in the United States each year. In addition, the disease results in more than $87 billion of U.S. economic burden annually. During the 2005–06 flu season, only one in five children ages 6 months to 23 months were fully vaccinated, and little more than one in 10 children needing two doses received both. Flu vaccine coverage varied widely among states, but no state had more than 40 percent of children fully vaccinated. Alarmed at low influenza vaccination rates in both adults and children, the Centers for Disease Control and Prevention (CDC), the National Foundation for Infectious Diseases (NFID), and other leading health organizations are increasing their efforts to urge Americans to be immunized against the flu this winter. The CDC and the American Academy of Pediatrics recommend that all children ages 6 months to 59 months receive a vaccination to protect against the contagious respiratory infection. Studies have shown that children younger than 5 years were hospitalized for flu-related reasons at rates similar to those for people ages 50 to 64. This emphasizes the need for improved flu prevention efforts for America’s youngest generation. While the CDC also recommends an annual flu vaccination for almost everyone who desires protection from influenza, it’s especially important for high-risk populations. High-risk groups include pregnant women, schoolchildren, people with chronic medical conditions, people older than 50, health care professionals, and all others in close contact with these high-risk populations. This is particularly important for those in contact with infants younger than 6 months, who are too young to receive influenza vaccine, and includes parents, grandparents, siblings, and child care providers. “Not only does annual influenza vaccination help protect yourself, it also helps create a ‘cocoon of protection’ for those around you,” said William Schaffner, M.D., vice president of the NFID. “Vaccination is the best way to prevent influenza from infecting yourself and others, including family, friends, schoolchildren, and co-workers — and is the right thing to do for your community this and every influenza season.” Healthy Children Winter 2008 5
Slide 6: [ Q&A To submit questions to Healthy Children, send an e-mail to healthychildren@aap.org or write to American Academy of Pediatrics, attn: Healthy Children Magazine 141 Northwest Point Blvd., Elk Grove Village, IL 60007 Ask the Pediatrician Solving the Riddles of Parenthood 1. Unraveling the Mystery of Autism Q: I recently saw a television program about the Measles/Mumps/ Rubella (MMR) immunization and autism. What exactly is autism, and is there a link between the vaccination and the condition? A: According to the Centers for Disease Control and Prevention (CDC), Autism Spectrum Disorders (ASDs) are a group of developmental disabilities that impair social, emotional, and communication skills. Many people with ASDs might repeat certain behaviors again and again and might have trouble changing their daily routine. They also have different ways of learning, paying attention, or reacting to situations. The cognitive abilities of people with ASDs can vary from gifted to severely challenged. ASDs begin before the age of 3 and last throughout a person’s life. Boys are four times more likely than girls to suffer from an ASD, which affects approximately one in every 150 children. There is no single best treatment package for all children with an ASD. Regarding immunization and autism, extensive evaluations by the American Academy of Pediatrics, the Institute of Medicine, and the CDC conclude that there’s no proven association between MMR vaccine and autism. The National Institute of Child Health and Human Development says, “To date there is no definite, scientific proof that any vaccine or combination of vaccines can cause autism. It’s important to know that vaccines actually help the immune system to defend the body.” To help pediatricians identify the signs and symptoms of an ASD as early as possible, guide parents through early interventions, and help families manage educational strategies and behavioral therapies, the AAP recently issued two comprehensive reports. Both reports are part of a new AAP practical resource for pediatricians called “AUTISM: Caring for Children with Autism Spectrum Disorders: A Resource Toolkit for Clinicians.” The kit includes screening and surveillance tools, guideline summary charts, management checklists, developmental checklists, developmental growth charts, early intervention referral forms and tools, sample letters to insurance companies, and family handouts. For more information, visit www.aap.org. 6 Healthy Children Winter 2008
Slide 7: 2. A Pajama Party Q: I have eight nieces and nephews all younger than 5 years old and wanted to give them all similar gifts for their birthdays. I decided to give each of them a pair of pajamas, but I had no idea there were so many safety considerations. Can you offer some advice on purchasing sleepwear? come into direct contact with people’s skin. Wash soiled sheets, towels and clothes in hot water and dry in a hot dryer. If a wound appears to be infected, take your child to a pediatrician. Treatment may include draining the infection and antibiotics. 4. Pass on Bumper Pads A: It’s wise to do your homework before purchasing this type of clothing because fabric and fit are important safety considerations for children’s sleepwear. The U.S. Consumer Products Safety Commission (CPSC) provides the following brief guide to federal requirements for sleepwear for infants to children’s size 14: Infant sizes up to 9 months: All infant sleepwear in sizes to 9 months may be made from either flame-resistant or non-flame-resistant fabrics. Flame-resistant sleepwear does not ignite easily and must self-extinguish quickly to meet the U.S. CPSC flammability requirements for children’s sleepwear. Flame-resistant garments may be worn either loose fitting or snug-fitting. Pajamas that are non-flameresistant are made from natural fabrics, such as cotton, and must be worn snug-fitting. This will not create an unreasonable risk of burn injuries to children. Infant sizes above 9 months to children’s size 14: Children’s sleepwear larger than size 9 months must either be flame resistant or fit snugly. 3. Spreading the Word on MRSA Q: What is MRSA? How can I protect my three teenagers against it? Q: My husband and I are preparing a nursery for our first child. Should we put bumper pads in the crib? A: Although bumper pads are a nice decorative touch that are designed to prevent a baby from being injured while in the crib or bassinet, a recent study says the risk of death or injury from using them outweighs their benefits. Pediatric researchers from the Washington University School of Medicine in St. Louis reviewed three U.S. Consumer Product Safety Commission databases for deaths related to crib bumpers and crib-related injuries from 1985 to 2005. They found that 27 children from 1 month to 2 years old died from suffocation or strangulation related to the bumper pads or their ties. They also found 25 nonfatal infant injuries attributed to bumper pads. “Many infants lack the motor development needed to free themselves when they become wedged between the bumper pad and another surface,” said Bradley Thach, M.D., professor of pediatrics and staff physician at St. Louis Children’s Hospital. “They are likely to suffocate because they are rebreathing expired air or their nose and mouth are compressed.” Thach recommended that parents not use bumper pads in cribs or bassinets. “I don’t think bumper pads are doing any good,” he said. “Although the deaths and injuries may be rare events, they are preventable by eliminating the use of bumper pads.” A: MRSA (methicillin-resistant Staphylococcus aureus) is a bacterium that causes infections on the surface of the skin or can go into the soft tissue to form a boil or abscess. MRSA has become a significant public-health concern because the bacterium has become resistant to many antibiotics, making the infections difficult to treat. Once limited to hospitals, medical centers, and nursing homes, MRSA (also called staph infection) is now commonly spread in schools, dormitories, military barracks, households, correctional facilities, and day care centers. Community-associated MRSA is often spread in crowded areas, through skin-to-skin contact, from cuts and abrasions from contaminated items and surfaces. The best ways to protect your children from getting MRSA at school or other public places include: Practice good hygiene. Make sure they keep their hands clean by washing them with soap and water or using an alcohol-based hand sanitizer and showering immediately after participating in sports or activities. Cover any skin abrasions or cuts your children have with a clean dry bandage until they’re healed. Don’t allow your children to share personal items — such as towels — with anyone. Have them use a barrier — such as a towel or clothing — between their skin and shared equipment, such as weight-training benches. Sanitize frequently touched surfaces and surfaces that Healthy Children Winter 2008 7
Slide 8: RSV When It’s More By Tracy A. Mozingo Than Just a Cold It looks and sounds like a cold, but respiratory syncytial virus (RSV) can become something more. What’s the difference? What should you do about it? And when should you take your child to a pediatrician? E ighteen-month-old Janie woke up with a fever, stuffy nose, and some crankiness. She was coughing, and her breathing seemed to be a little labored. Great — another cold, her mom thought. But is it a cold, or could it be respiratory syncytial virus (RSV)? If your child is otherwise healthy, like Janie, then RSV may only produce the symptoms of the common cold. Wheezing and grunting with each breath or fast breathing may also occur. When It’s More of a Concern But if a premature infant, a young infant, or a child with a health condition that affects the lungs, heart, or immune system comes down with RSV, then the impact can be much greater. Those at high risk could develop bronchiolitis or pneumonia. In fact, RSV is the leading cause of infant hospitalizations for bronchiolitis in the United States, according to Henry Bernstein, D.O., FAAP, Chief, General Academic Pediatrics at Children’s Hospital at Dartmouth and Professor of Pediatrics at Dartmouth Medical School. “An infant’s chest wall is not very stiff because it is not well-developed,” says John Bradley, M.D., FAAP, Director, Division of Infectious Diseases, Children’s Hospital San Diego. “An older child has a better-developed chest wall and can cough up the mucus caused by RSV. But a baby can’t do this, so they are more likely to have plugged airways and a greater risk of further inflammation. That is why RSV is such a concern for the very young.” Like most other common colds, RSV is highly contagious and most often occurs in fall and winter (roughly November through April). It can spread directly from person to person, or indirectly when someone touches any object infected with the virus, such as toys, countertops, doorknobs, or pens. Children under the age of 2 are most frequently affected by the very serious symptoms of RSV. Prevent the Spread The best defense against RSV is to teach and encourage good handwashing habits to your 8 Healthy Children Winter 2008
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Slide 10: When to Call the Doctor Children may need treatment if they show any of the following symptoms: Great difficulty or fast breathing Excessive wheezing Gray or blue skin color High fever Thick nasal discharge that is yellow, green, or gray Worsening cough Extreme tiredness (especially during times they are normally active) children. In fact, this is the most effective way to avoid infection. Also, try to steer clear of anyone who has obvious symptoms of a cold as much as you can. Because RSV is so infectious, it spreads easily and quickly at shopping malls, child care centers, and schools. Many times, younger children are infected because an older child brings the virus home. If one child comes down with the virus, it is best to separate the child who has symptoms from others until the symptoms subside. If at all possible, parents of premature or very young infants and parents of children with a health condition that affects the lungs, heart, or immune system should keep their children away from child care centers during the peak of RSV season. “Those with RSV can shed the virus for as long as a week,” says Dr. Bernstein, a member of the American Academy of Pediatrics (AAP) Committee on Infectious Diseases.. “That makes it necessary to keep the infected separated from those who have no symptoms for quite some time.” Also, steer clear of tobacco smoke. “Avoiding smoking is key,” Dr. Bernstein emphasizes. “Parents who smoke are more likely to acquire viral respiratory infections and then pass them on to their children.” children who have heavy scarring of the lungs because they were on a respirator at birth. The antibodies help reduce the likelihood of the child developing pneumonia and can therefore prevent a hospital stay. “These injections are technically engineered, very expensive, and not for every child. But they can make at-risk babies far less sick than they would be otherwise,” says Dr. Bradley, who is also a member of AAP’s Committee on Infectious Diseases.. Because RSV is a virus rather than a bacterial infection, it cannot be treated with antibiotics, and there is no vaccine available yet. “A vaccine is in the laboratory stage, but we probably won’t see anything in human trials for the next couple of years,” Dr. Bradley explains. “And because even natural infection with the virus does not provide perfect immunity from getting RSV again, a vaccine will most likely not provide perfect immunity either.” So what’s a parent to do with a child suffering from RSV? Here are some guidelines: Give plenty of fluids. Use a cool-mist vaporizer during the winter months to keep the air moist. (Be sure to clean the vaporizer regularly.) Blow little noses frequently (or use a nasal aspirator for infants). Give non-aspirin pain reliever, such as acetaminophen. Aspirin should not be used because it has been linked to Reye syndrome, a disease that affects the brain and liver. Knowing how to avoid spreading the virus can help keep your children healthy. And recognizing the symptoms that signal greater inflammation can prevent a trip to the hospital for those a higher risk. The good news is that the majority of children who come in contact with RSV will never know they had anything more than just a “bad cold.” ● Diagnosis and Treatment If a child is otherwise healthy, there is really no need to obtain a formal RSV diagnosis. The condition will generally run its course without specific medical treatment. If your child is at higher risk as a premature infant or because of other medical conditions, then a doctor can diagnose RSV by taking a swab of nasal fluids. Doctors can also decide which young or premature infants might benefit from RSV antibodies during the peak season. This would likely be 10 Healthy Children Winter 2008
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Slide 12: Your youngsters got through their summer activities in one piece, and winter is upon us. But now is not the time to get lazy with safety. By Emily Harris o your young ones survived summer — open water, sunburn, mosquitoes, ticks, and all — thanks in no small part to the safety precautions you took. Now they’re looking to get ready for winter sports. What should you do to help them prepare? It may be cold outside, but it’s just as important for children to get physical activity during the winter as it is during the warmer months. Physical activity should be a healthy part of your family’s routine throughout the year. And safety should always be a central part of your children’s recreational fun. S Even though it might seem odd, you can get sunburn in the winter. The sunlight reflects off snow and ice. Wear sunscreen with an SPF 15 minimum and cover exposed areas of the body. You should wear protective eyewear and an SPF lip balm, Benjamin says. Safety in Layers When thinking about outside activity, think about clothing, too. Layering is a good idea; so are moisture-wicking fabrics and clothing that’s geared to the sport. Keep in mind that regulating body temperature is more difficult in younger children (just as it is during warm weather), so hypothermia can occur more easily. “Kids can sweat, too, when they’re warm,” says Dr. Benjamin. And that sweat can chill them quickly when it gets exposed to the cold air as they remove layers. “I think with winter sports safety, especially with kids, the temperature and the environment are near the top of the list in importance. And I think that parents have to be really proactive and responsible about dressing them appropriately in layers, covering their heads and necks.” Fun in the Winter Sun It’s true that many safety concerns are the same regardless of season, says Holly Benjamin, M.D., FACSM, FAAP, the director of primary care sports medicine program at the University of Chicago Student Care Center. For starters, parents still need to remember sunscreen, for example. “People come back from ski trips and we actually treat a fair number of sunburns,” she says. Chillin’with Safety Healthy Children Winter 2008 13
Slide 13: Watch out for fashion trends that could land you in the ER. Long scarves and cords can get caught in sled blades, and hoods can block peripheral vision, she says. “Some people believe that it’s safer to just have a hat, neck warmer, a warm jacket and gloves,” she says. As long as the exposed skin is covered and the jacket can be zipped, your child should be ready for winter play. Stay Alert Injuries can happen anywhere, anytime. Dr. Benjamin’s advice follows that of the American Academy of Pediatrics (AAP): Be aware and use caution. Children should always wear helmets while sledding, skiing, snowboarding, and playing ice hockey, for example. fractures — commonplace in snowboarding — can be prevented by simply using wrist guards. Safety is key in ice hockey or sports involving equipment, Dr. Benjamin says. “The biggest challenge with kids is fit, making sure everything fits properly and is the right size. And that changes. No one wants to buy new skates every year, but it may be necessary as your child grows.” Used equipment is fine, she says, but check it out before you buy it. Look at the laces, for broken blades and make sure the leather on hockey and ice skates isn’t too broken down around the ankles. Follow the team guidelines, too. If you need a mouth guard, wear one. “A piece of used equipment that fits well and is in good condition is better than something new that doesn’t fit properly,” Dr. Benjamin says. Physical activity should be a healthy part of your family’s routine throughout the year. “If you’re talking about sledding or tobogganing, especially with young kids, they’re not always looking for trees or rocks, so you have to scope out the environment and make sure they have a clear path,” she says. Parents should also make sure that the hill your children are sledding down doesn’t empty onto a pond that might not be frozen solid, she says. Older children should play it safe, too, she says. Don’t load up the sled with multiple riders; take turns. “Reckless play — actively trying to crash into each other or knock people off is obviously a setup for injury.” “It’s fun for kids to enjoy winter sports,” Benjamin says, “and we’re fully supportive of kids participating in winter activities as long as they follow safety guidelines.” You have to check all equipment, new and old, to see that it fits. You need to check it to make sure it’s still safe or not broken. If it gets used a lot, it may not hold up. Make sure helmets and boots are sized correctly. Make sure the equipment is in good shape. If you’re concerned, ask a sales person at a ski shop, she says. Skills Assessment If it’s a new activity, work to master your skills, she says. Play it safe by starting with a snowboarding lesson before you hit the slopes. It’s recommended, appropriate and safe, she says, to start slow or on a more gentle slope. Practice with your equipment and gradually build up to a steeper slope or faster speed. Be patient and resist pressure to take on more than you’re ready for. By taking a few precautions, you can make sure that your children get the healthy benefits of winter exercise without taking unnecessary risks. ● Equipment Check If you’re planning a skiing or snowboarding trip, have the equipment fitted by a professional. A child in too-large boots can trip and fall. A child in skis that aren’t the right size can fall, too. And keep in mind that wrist 14 Healthy Children Winter 2008
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Slide 15: Good Reasons to Smile A healthy mouth and teeth are an important part of a child’s wellness. So when should a child go in for his first dental exam? What’s the best way to take care of a baby’s teeth? How can you build good dental habits with your children, regardless of their ages? Here’s what you need to know. By Deanna A. Stephens o you remember learning how to take care of your teeth as a child? Perhaps there was an upbeat rhyme that kept you on task when brushing, or maybe cartoon images of milk come to mind. Maybe you’re old enough to remember those red tablets that, once chewed, showed where you missed brushing. Though this time marked a turning point in your independence, the road to your oral health began much sooner. Even babies’ mouths can develop a buildup of damaging bacteria along the gums, a problem that can be preventing by wiping them with a soft, damp cloth after feedings. Some of the advice pediatricians include in a total wellness plan also speaks to keeping baby’s mouth and teeth healthy. Nutritional needs come into play. And for all the advice you might have received about helping your child sleep by putting her to bed with a bottle, this is perhaps the biggest contributor to preventable decay and early cavities. “In our clinic at Duke Children’s Hospital, we see children under age 3 every week with significant tooth decay. Restoring these teeth to a healthy state is not only emotionally challenging for the child but a major financial burden to the family,” says Martha Ann Keels, DDS, Ph.D., a pediatric dentist in Durham, N.C., who treats baby bottle tooth decay. D Getting Dental Help Healthy teeth are crucial for speaking and for chewing solid food. Whether you’re in the midst of the long nights that might accompany infant teething or your child has a full set of pearly whites, it’s a good idea to brush up on just what to do next. And according to Dr. Keels, there’s now consensus among four major national entities all recommending that children should have an oral health risk assessment by their first birthday. A child’s first trips to a pediatric dentist can give parents good guidance for taking care of a child’s teeth, gums, and mouth. It’s a good time to find out how to encourage your child to be proactive about dental hygiene, and get answers to your questions about everything from feeding to using pacifiers. The dentist also will explain how to spot potential problems, such as the white chalky spots that indicate dental caries, an early dental disease. According to Dr. Keels, caries is the most common problem diagnosed in young patients. “Parents need to know that the white spot lesions are reversible — they can be re-mineralized with a combination of remedies, such as diet changes and fluoride varnish,” explains Dr. Keels. “If the white spot is left unattended, it may quickly advance into an irreversible cavity.” Healthy Children Winter 2008 17
Slide 16: Peace of Mind Even for adults who haven’t been faithful in getting their own routine checkups, parents often want what’s best for their children, and this includes getting appropriate dental care. Adding a dental professional as a resource to your support system can provide ongoing peace of mind for your entire family. Dr. Keels relates her experience of examining a 12-month-old for the first time on a recent morning. Later that same day, the child fell and pushed her teeth up into her gums. “It is not uncommon for a toddler to fall and have dental trauma when learning to walk. In the scenario where the child already has a dental home at age one, that family knows where to go for help,” says Dr. Keels. “In the scenario where they have not seen a dentist yet, it will be doubly stressful to find a provider.” The Golden Rules for Raising Cavity-free Kids Support good dental health by taking care of your child’s gums and teeth on a daily basis. Once the child is old enough to “do it by herself,” continue monitoring daily habits and self-care. Be selective about any type of beverage you put in your child’s bottle or sippy cup besides water. Remember, dentists often refer to juice and soda as “liquid candy.” Keep a bottle or sippy cup away from your child’s naptime and nighttime slumbers. Liquids tend to stick to the teeth because the mouth is drier during sleep. Finding the Right Dentist David M. Krol, M.D., FAAP, associate professor and chair of pediatrics at University of Toledo Reward children with hugs, stickers, and toys instead of desserts and College of Medicine, says that he “wholeheartcandy. Sugary foods leave behind a sticky coating that converts to edly” supports an oral health risk assessment by harmful bacteria and enamel-eating acid. But if you feel compelled one year of age. It’s the best way to build to give your child an occasional sweet, choose one that melts rapidly knowledge about how to care for a child’s teeth, instead of gummy candy. and to build the good habits that are key to prevention, he says. “This is the ideal, as children Serve up calcium-rich foods such as yogurt, cheese, will hopefully be connecting with a dental home and milk, along with plenty of vitamin-heavy before they need any serious intervention and can vegetables to help your child maintain strong, develop a strong and positive relationship with a healthy teeth. Build good habits early by giving dentist,” Dr. Krol points out. your child healthy treats in place of sweets at Experts suggest that you approach locating a snack time. pediatric dentist with the same seriousness and energy you invested when finding a primary care Talk to your child’s pediatrician or dentist physician. Obtain names of area pediatric dentists about the appropriate amount of from trusted friends, professionals, and health fluoride your child needs. organizations. Your child’s existing pediatrician, along with your own research on the Internet and through your dental insurance provider, can serve as solid starting points, too. Dr. Krol advises parents to ask themselves some simple questions after selecting a pediatric dentist for a first-year visit, such “How does the dentist interact with children? Will they see the same dentist each time they come in?” Most importantly, he points out, If you’re at all worried about the prospects of a squirmy baby or parents should not underestimate their own comfort level when rambunctious toddler in a quiet office setting, you’re not alone. It might committing to a regular dental provider. help to remember that you are seeking the expertise of a professional whose career is dedicated to working with kids. A pediatric dentist receives an additional two to three years of specialized training over that The Exam: What to Expect of a non-specialized dentist. And while maintaining a toy-filled waiting Almost all pediatric dentists will perform a thorough exam of the room might not be necessary to obtaining credentials, it most certainly is mouth and teeth while the child is comfortably situated on the parent’s the norm. ● lap. Using a lap pillow as a prop, some dentists may have the child lean back onto the pillow while holding his parent’s hands. As further comfort to hesitant moms and dads, Dr. Keels says, “I reassure parents that it is completely normal for the child to get upset with having to lean backwards, but that the exam is very quick and the toddlers quickly recover once the child is allowed to sit up.” 18 Healthy Children Winter 2008
Slide 17: [ Newborns Fever Without Fear By Trisha McBride Ferguson et’s face it, fevers can be scary for parents. But even though infants get their share of colds and fevers, fevers should be taken more seriously. When your baby is burning up, it can be hard to think straight and make important decisions. Learning what causes fevers and how to treat them will ease your anxiety and help you take control of the situation. A fever in a newborn should not be taken lightly but it helps to know when to take action to and when t let it run its course. When to Call the Doctor Your child is younger than 2 to 4 months old and has a fever. Your child is lethargic, unresponsive, refuses to eat, has a rash, or is having difficulty breathing. You observe signs of dehydration, such as a dry mouth, a sunken soft spot, or significantly fewer wet diapers. Your child’s fever lasts more than a few days. Your child experiences a febrile seizure (see “Febrile Seizures” sidebar for explanation). L What causes a fever? “Fever is usually, but not always, an indication of some infection in the body,” explains Dennis Vickers, M.D., FAAP, chairman of pediatrics at Sinai Health Systems in Chicago. “It is the body’s first line of defense in fighting infection.” Everyone has his or her own internal “thermostat” that regulates body temperature, and normal body temperature is around 98.6 degrees Fahrenheit plus or minus about one degree (37 degrees Celsius, plus or minus about 0.6 degrees). When the body detects an infection or other illness, the brain responds by raising the body temperature to help fight the condition. “Any rectal temperature over 100.4 is generally considered a fever,” says Barbara Huggins, M.D., FAAP, professor of pediatrics at the University of Texas Health Center at Tyler. “A fever itself doesn’t necessarily warrant a call to the doctor. It depends on the age of the child and his other symptoms. 20 Healthy Children Winter 2008 Managing the Fever A fever can’t always be detected by feeling your infant’s forehead. It’s usually necessary to take his temperature as well. Although there are numerous thermometers on the market that measure temperature in different areas, parents should use rectal thermometers with their babies for the most accurate reading. “The ‘gold standard’ measurement is still the rectal temperature,” says Dr. Vickers. Once you’ve identified a fever, you can begin treating it if needed based on your child’s age and other symptoms. While you may instinctively
Slide 18: How to take a rectal temperature Taking a rectal temperature is the most accurate way to measure a young child’s true body temperature. The American Academy of Pediatrics encourages parents to remove mercury thermometers from their homes to prevent accidental exposure and poisoning. Here are the steps for taking a rectal temperature: 1. Use a rectal thermometer (preferably digital) that has a round bulb at the end. 2. Clean the tip of the thermometer with rubbing alcohol or soap and water. 3. Lubricate the tip with a water-soluble lubricant. 4. Place your baby on his stomach across a firm surface or your lap. Or, if your child is more comfortable on her back, gently lift her legs and proceed to step 6. 5. Stabilize your child by placing one hand on his lower back just above the buttocks. If your child is wiggling, ask someone to help you restrain him. 6. Slowly insert the lubricated thermometer into the anal opening about one-half inch, stopping if you feel any resistance. Never force the thermometer. 7. Gently hold the thermometer in place between your index and forefinger while keeping your hand against your baby’s bottom. 8. Wait until your thermometer beeps or signals that it’s done. A reading of 100.4 degrees Fahrenheit or more is generally considered to be a fever. Febrile Seizures What are they? A febrile seizure is a relatively common and harmless side effect of fevers in young children. What does it look like? It’s a full-body seizure where your child may be unresponsive, look strange, twitch, stiffen or roll his eyes. What should you do? Remain calm and move your child to a safe place where he can’t hurt himself. Do not put anything in his mouth. Febrile seizures usually last less than one minute, but can last up to 15 minutes. Call 911 if the seizure lasts longer than a few minutes. Follow up with your pediatrician for all febrile seizures. want to bring your child to the doctor’s office, it may not be necessary, especially if the child seems fine once the fever is reduced. “What I tell parents when they call me in the middle of the night is, ‘Don’t panic.’ Fever by itself is not something to panic about. I ask them how the child looks and how they’re acting — are they behaving normally?” says Dr. Huggins. “Then we focus on how to get the fever down. With the vast majority of viral infections, once you get the fever down, everything’s better.” Keeping Fever at Bay Although not every fever needs to be treated, there are some things you can do to help make your child more comfortable. Giving a child acetaminophen or ibuprofen will usually reduce a fever. “Make sure you’re giving the appropriate dose,” advises Dr. Huggins. “Refer to the label and if they’re under two years old, contact your pediatrician or pharmacist.” Common sense is equally important for treating fevers, says Dr. Vickers. “Use your head. Don’t overdress the child, no matter what grandma says.” The same goes for giving baby an alcohol bath, an old practice that is no longer recommended. A fever will also cause a child to lose fluids more quickly, so offer your baby plenty of fluids to avoid dehydration. Signs of dehydration include crying without tears, a dry mouth, and fewer wet diapers. Being prepared can help take the fear out of fever. Keep your digital thermometer ready and accessible so you don’t have to search for it once your child is ill. Have children’s acetaminophen or ibuprofen on hand. And make sure your pediatrician’s phone number is handy. ● Healthy Children Winter 2008 21
Slide 19: [ Children Positive Parenting By Margie Markarian hether it’s sneaking a snack before dinner, refusing to finish up a video game, or whining all the way to the mall, misbehaving is an inevitable part of childhood. It’s no secret that effective parenting involves knowing how to respond when kids act up and steering clear of meltdown situations. It also means setting limits so kids know when they are crossing the line between acceptable and unacceptable behavior. “The gentlest way to set limits is to establish routines and rules so that children know what’s expected of them,” says Pamela C. High, M.D., FAAP, and director of developmental-behavioral pediatrics at Hasbro Children’s/Rhode Island Hospital in Providence. “When children are young, the easiest kinds of limits to set are the ones about safety, like ‘Don’t touch the stove’ and ‘Hold my hand when you cross the street.’” How To Encourage Good Behavior W Quality Time In spite of busy lifestyles, it’s also important to spend quality parentchild time together each day. “Even if it’s only five, 10, or 15 minutes, children are looking for attention and need some special time,” says Dr. Vickers. Even when the number of spare minutes in your day is scarce, remember that quality time “… goes a long way in keeping children from using negative behavior to get your attention.” Family meals and bedtime stories are ideal opportunities for parents and children to catch up and connect in positive ways. “But doing different things on different days works, too,” acknowledges Dr. High. The point is to be focused on your child, which can happen whether the two of you are chatting during a walk to the store, making dinner together, playing a board game, or high-fiving each other after a soccer match. Good Rules, Good Rewards As kids get older and the situations they face become more varied, parents tend to have more ambivalence about rules, says Dr. High, who is also a professor of clinical pediatrics at Brown University’s Medical School. Nonetheless, rules about no TV until homework is done and being in pajamas and ready for bed by 8:15 on school nights has a way of warding off conflict. “Children want to know the boundaries and what the rules are,” says Dennis Vickers, M.D., FAAP, chairman of pediatrics at Sinai Children’s Hospital in Chicago. “Discipline is really more about guiding children toward positive behavior than it is about punishment.” Both pediatricians recommend adopting a parenting style that encourages and recognizes good behavior with words, smiles, and hugs. They also urge parents to get in the habit of catching their children doing things right. “Noticing and complimenting kids for hanging up their jackets, setting the table, and keeping a baby brother amused while you cook supper reinforces the types of positive behavior you want to see again and again,” says Dr. High. Measuring Discipline For those unavoidable times when kids need discipline, consider the following approaches to doling out punishment: Establish logical consequences. To the degree possible, the consequence of any misdeed should relate to the offense in a sensible, easy-to-understand way. For example, if your kids are fighting over a toy after you’ve given them the chance to work things out, simply take the toy away for 24 hours and then let them try again. Similarly, if your son “forgets” to wear a helmet when he’s riding his skateboard, help him to “remember” by not letting let him ride the skateboard for at least the rest of the day. Take away privileges. Sometimes it’s not possible to come up with an appropriate consequence. That’s when withholding privileges becomes an effective strategy. Just be sure to take away a privilege your child deems valuable and isn’t a basic need. Children above the age of 4 or 5 understand it when you tell them: “You can’t have a friend over this weekend because you didn’t do your household chores” or “You won’t be able to watch the your favorite TV show tonight because you borrowed your sister’s paint set without asking and then messed up all the colors.” But keep in mind that younger children don’t understand 22 Healthy Children Winter 2008
Slide 20: the long-term consequences of their actions as well. Call for a timeout. Timeout remains a tried-and-true discipline tool for escalating behavior problems because it removes attention from the negative behavior. They are especially helpful in calming tantrums and defusing aggressive behaviors (biting, hitting, throwing), as well as for responding to willful disobedience, back-talk, interrupting, and sometimes whining. Experts agree that timeouts should last one minute for each year of life up to age 11 or 12. Timeouts should take place in a safe, boring home location that is free from entertaining distractions and does not frighten your child in any way. When the timeout is over and you and your child have both calmed down, explain why the behavior was unacceptable and move on. Remember that your ultimate goal isn’t to separate your child, but to give him a little time to calm down and then re-engage in what’s going on around him. Ultimately, the best way to encourage good behavior is to lay the groundwork early by being a good role model and demonstrating a consistent, loving approach to discipline. It’s also important to have patience and maintain a flexible attitude, because there are always going to be times when kids are being annoying but not really doing any harm. And, as Dr. Vickers points out, “It’s okay to let little things stay little things.” ● Margie Markarian is a freelance writer in Franklin, Massachusetts. She specializes in writing about health, parenting, and family life. Discipline No-Nos for Parents No hitting or spanking. Physical force hurts and teaches kids that violence is an acceptable way to show anger and solve problems. The American Academy of Pediatrics strongly opposes striking a child. No labels. A child may exhibit “bad behavior,” but a child should not be called a “bad boy” or a “bad girl.” No unreasonable expectations. Expect your child to test limits, and recognize that it is your job as a parent to consistently (and as calmly as possible) teach consequences. Avoid situations that invite meltdowns and keep your child’s age, temperament, and maturity level in mind as you go through the course of the day. If, for example, you know your child is tired and hungry, then don’t expect perfect behavior at the supermarket. No idle threats. Don’t render yourself ineffective by saying things like, “I won’t buy you a toy if you don’t stop whining,” only to give in and buy the toy later. Kids quickly learn that you’re not true to your word, and will take advantage by not complying with your requests. Avoid inconsistencies. You may feel one way, your spouse might feel another way, but back each other up in your child’s presence. Then, discuss your different approaches privately. “When you don’t present a united front, children figure it out very quickly and capitalize on it,” says Pamela C. High, M.D., FAAP, and director of developmental-behavioral pediatrics at Hasbro Children’s/Rhode Island Hospital in Providence. Healthy Children Winter 2008 23
Slide 21: [ Adolescents Ah, “the talk.” As uncomfortable as it can be, talking to your adolescent about sexuality is absolutely necessary. Here’s how to start the conversation, and keep it going. 24 Healthy Children Winter 2008
Slide 22: Adolescent Sexuality Talk theTalk Before TheyWalk theWalk By Keith Ferrell dolescence can be tough enough to get through without questions of sex, sexuality, and sexual identity. But adolescents are humans, too — no matter how alien they may seem to their parents at times. Openly addressing the all-too-human questions of sexual development, sexual desire, and the nature of the adolescent’s developing sexual identity are critical. Sharing factual information with and giving good moral guidance to your teenager is a vitally important part of helping your teen understand herself or himself. It can help your child avoid devastating, and possibly life-threatening, errors in judgment. “Above all, it is critical that parents be truthful, honest, and available to their children,” says Charles R. Wibbelsman, M.D., FAAP, Chief of Adolescent Medicine at Kaiser Permanente in San Francisco and a member of the American Academy of Pediatrics’ Committee on Adolescence. “Parents often have their own agenda — don’t do this and don’t do that. But they need to take a step back and leave the judgments aside for this discussion,” says Warren Seigel, M.D., FAAP, Chairman of the Pediatrics Department and Director of Adolescent Medicine at Coney Island Hospital, Brooklyn, N.Y. “The most appropriate and important thing for a parent and a child or adolescent in dealing with questions about sexuality and sexual health is an open channel of communication.” A The Messages They Get In today’s hyper-sexualized culture of Internet sites, mass media entertainers, and 24/7 programming, the traditional “birds and bees” lecture (or pamphlet handed to the child to read on her or his own) on reproductive basics is completely inadequate. Carefully preparing children for the normal changes in their bodies as well as the endless assault of peer pressure, media glorification of irresponsible sexuality, and advertising come-ons is the only way to create a sense of security for parents and children alike. “There are a lot of things in the media that are not appropriate for a particular age,” says Dr. Wibbelsman, who is co-author of The Teenage Body Book and Growing and Changing. “We don’t put children on the street and wish them luck before sending them out on their own. We hold their hands. We educate them about the risks. And we trust them with increasing responsibility only as they’re old enough and show they’re ready to handle it.” “The media particularly and everything around us talks about sex,” adds Dr. Seigel. “It’s hard to avoid it.” The only foolproof approach to sexual safety, of course, is to say “no” and defer sexual activity until later in life. The good news is that as many as half of all adolescents do just that. But that leaves the other half at risk — many of them engaging in unprotected sex, exposing themselves to potentially grave disease and unwanted pregnancy. “The most important thing to teach your child is responsibility,” Dr. Seigel says. “Discuss how to make decisions and understand what the consequences of decisions will be. You can start by discussing decisions and consequences that don’t involve sex, and then move the conversation toward sexuality. After all, there are consequences to having sex or not having sex, and every child is going to get a lot of misinformation along the way from their peers and the media.” The pressures upon children — from peers and also the media as mentioned above — may actually offer one of the most effective pathways to opening what must be an ongoing dialogue about sex and sexuality, not a single talk or lecture. What to do, then? It’s good to turn these encounters with the media into teachable moments. “Seeing something in the media that is obviously sexually charged can be a springboard for conversation between adolescent and parent,” says Dr. Wibbelsman. “Is the ad bad or good? What’s the ad trying to say? Use this moment as an opportunity to teach and encourage, not to pronounce a harsh, dismissive judgment. By engaging the child and building his self-esteem and her confidence in her ability to make judgments, you’re showing him that you respect what he’s learning and how she’s growing in her decision-making.” After all, however adult their appearance, behavior, and attitudes may appear, adolescents remain closer to childhood than adulthood, and children need ongoing parental guidance to prepare for adulthood. “I know it’s a lot of work, but parents need to monitor what their children see and be there, available to Healthy Children Winter 2008 25
Slide 23: them, to provide some context,” says Dr. Wibbelsman. “Find out what’s in the movie, what’s in the program, what’s on that Internet site before you let your child see or hear. And experience with him or her together, so you can discuss it and use it to build trust between you.” Helpful Resources For more information about talking to your child about human sexuality, visit these Web-based resources: The American Academy of Pediatrics: aap.org/healthtopics/ sexuality.cfm The Mayo Clinic’s Teen Health section: Starting the Discussion So when is the right time to start talking about sex www.mayoclinic.com/health/sex-education/CC00032 with your child? It’s a good idea to start laying the groundwork for these conversations long before the The National Campaign to Prevent Teen Pregnancy: onset of puberty. The more frequently and frankly www.teenpregnancy.org sexual matters are discussed, the easier and even more Nemours Foundation: open such discussions are likely to be as you both grow comfortable with talking about it. “Let’s face it, we’re all • Talking about puberty (kidshealth.org/parent/growth/ embarrassed to talk about sex with each other,” Dr. growing/talk_about_puberty.html); Seigel says. “The easiest way to start is to be real with • Abstinence (kidshealth.org/teen/sexual_health/ your adolescent: ‘This is really hard for me to talk contraception/abstinence.html) about, and it was hard for me to talk about with my dad when I was your age.’ But it’s important to talk about, and we have to talk about embarrassing things sometimes.” “Helpful Resources” at the top of this page for reliable resources of Keep reminding your child that you are in her corner every step of the information on these subjects.) way. “Never let them forget that your love is unconditional,” Dr. Seigel says. “Tell them, ‘I am here with you, and I love you and I will be here with you no matter what through all of this.’ Yes, it’s much easier said Countering the Pressure than done, but no less important.” One key area to emphasize is that no one has the right to pressure So what should you talk about? Perhaps start with how sexuality is your daughter or son to have sex. Peer pressure — and the media portrayed in the media and, far more importantly, how it “works” in real pressure that often stimulates it — can be addressed by empowering life — the potentially bad consequences and catastrophes than can be a your children with your belief in their ability to withstand such pressure, result of sexual activity, as well as the pleasure and positive results of a sense of values that are more important than immediate gratification, responsible sexuality (remember: the job here is to be honest.) “You see a and their absolute freedom to bring any concerns to you. character in a TV show who’s made a decision with regard to sex,” Dr. It is wholly natural for adolescents to have questions about sex and Seigel says. “Start the discussion there, but don’t make it your soapbox. sexual identity. While attitudes toward gay and lesbian identity (among If you harshly criticize what you’re both seeing, your child will assume other issues) remain tangled and complex, the crucial thing to bear in there’s no discussion to be had, and there goes your channel mind is that all of us have such questions at one time or another. of communication.” “Parents need to be open about that and understand the entire spectrum By approaching the topic carefully and conversationally, you and your of sexuality and sexual orientation, and not try to funnel them into a child are much more likely to sort through the complexities together. particular niche or area,” says Dr. Wibbelsman. “Accept the adolescent’s questions as part of growing up, because that’s exactly what it is. But at the same time, let the adolescent know what your views and values Keeping the Channels Open are. Know the difference between facts and your opinion, and be clear As your child matures — physically, mentally, and emotionally — about both.” opportunities will emerge for making regular discussions about sexuality But how to do it in a way that helps keep the channels open? It’s a part of your continuing conversation. Obviously, changes in your child’s four-letter word, actually. “The key is to let adolescents know that you body as puberty begins are crucial markers for such conversations. love them no matter who they become,” Dr. Seigel says. “They may One area that should receive particular attention is “urban myths” — turn out tall, short, heavy, thin, healthy, or sickly — but you’ll love bits of false information that “everyone” knows, passed along from them no matter what, no matter what decisions they make. That is much adolescent to adolescent (and even from generation to generation: Don’t easier said than done for many parents, but that’s key to raising a be surprised to find that your child has heard some of the same myths healthy adolescent.” and misinformation that circulated during your adolescence). Make And don’t hesitate to discuss values, morals, and ethics with regard to clear, for instance, that oral sex is not without risks, that unprotected sex — without lecturing, but with guidance. By providing your child intercourse without ejaculation is not effective birth control, and so on. with a solid framework of information and values, you’ve taken a large “It’s very important to get the facts straight from the start, and share step toward making sure that when he or she becomes sexually active it those facts with your child,” says Dr. Wibbelsman. “That builds trust, will be with the knowledge, preparation, and maturity that will mark the and that trust is critical to guiding your adolescent through these transition to sexual activity as an informed choice, not a risky accident. ● challenging times.” In particular, be specific and accurate about the risks or pregnancy, the effectiveness (and limitations) of different types of birth control, and the variety of sexually transmitted diseases (STDs) and their effects. (See 26 Healthy Children Winter 2008
Slide 24: [ Home Health By Cari Jackson For some children, the change in season brings with it a shift in mood. Is it a passing phase, or something more serious? Here’s what you need to know about depression, SAD, and your child. epression can b a serious problem f adults and children alike. i be i bl for d l d hild Regardless of the season, shifts in a child’s mood and/or attitude are not something to ignore or dismiss. What appears to be a teenager’s newly developed bad attitude could actually be a case of depression or, in some instances, Seasonal Affective Disorder. Seasonal Affective Disorder (SAD) — often referred to as “winter depression” — is a subtype of depression that follows a seasonal pattern. The most common form of SAD occurs in winter, although some people do experience symptoms during spring and summer. While SAD is almost always talked about in terms of adults, children and adolescents are not necessarily immune. “SAD might exist among children, but it has not been well studied,” says Eve Spratt, M.D., MSCR, associate professor of pediatrics and psychiatry at the Medical University of South Carolina. “I am not aware of any evidence-based studies that have examined SAD rates or treatment in children.” D Healthy Children Winter 2008 27
Slide 25: Helpful Resources American Academy of Pediatrics: Tips on Preventing Teen Suicide (www.aap.org/advocacy/childhealthmonth/prevteensuicide.htm) National Institute of Mental Health: Depression in Children and Adolescents (www.nimh.nih.gov/health/topics/depression/ depression-in-children-and-adolescents.shtml) Mental Health America: Children’s Depression Checklist (www. mentalhealthamerica.net/go/information/get-info/children-sdepression-checklist) A Season’s Symptoms SAD usually develops in a person’s early 20s, and Nemours Foundation: Understanding Depression (kidshealth.org/ the risk for the disorder decreases as you get older. parent/emotions/feelings/understanding_depression.html) SAD is diagnosed most often in young women, but men who have SAD may suffer more severe symptoms. People with a family history of SAD or those who live in northern latitudes where daylight hours during winter are shorter are at a higher risk for developing SAD. “In general, SAD is a better-recognized disorder in adults because so As winter approaches, 10 to 20 percent of us begin to suffer mild symptoms of SAD. We are saddened by the shortening days, climb into many children’s mental health disorders emerge over time,” says Dr. bed earlier and resent waking up when the morning light grows dim. For Spratt. “Diagnosing SAD in a child is not easy, because determining the 14 million Americans, these symptoms grow considerably worse as pattern of depression takes time. A doctor will typically attempt to determine whether a child is suffering from depression or anxiety first, winter progresses. People with SAD may crave comfort foods, including simple carbs then look at the pattern over time.” such as pasta, breads, and sugar. With excess unhealthy calories and a In order to diagnose SAD, doctors need to perform a medical exam to lack of fresh fruits, vegetables, and whole grains, fatigue often sets in. rule out other possible causes of the symptoms, such as hypothyroidism, hypoglycemia, or mononucleosis. Doctors can administer questionnaires They may become depressed and irritable. Eventually, they are no longer able to maintain their regular lifestyle. They may withdrawal socially and to determine mood and also to look for a seasonal pattern. “It’s difficult no longer enjoy things that used to be fun. It’s as if a person’s batteries to diagnose children with depression in the first place, because it often have just run down. For parents, SAD can obviously have a sharp impact presents as irritability, and they have a hard time understanding terms like ‘sad mood’ or ‘feeling blue,’” says Dr. Spratt. She points out that one on the ability to be an effective parent. of the most telling markers of depression in children is anhedonia — Children and adolescents can also suffer these symptoms. They may experience feelings of low self-worth and hopelessness. Children with which means “absence of pleasure.” “So a good screening question to ask children is, ‘When was the last time you had a really good time?’” depression struggle to concentrate on their schoolwork. Their grades may drop, worsening feelings of low self-esteem. Symptoms that last more than two weeks are cause for concern. Treating SAD Spring and summer SAD is characterized by anxiety, insomnia, Several effective treatments can help adult sufferers of SAD. Simply irritability, and weight loss. The symptoms more closely resemble mania bringing more sunlight into your life can treat mild cases. Spend time than depression. outdoors everyday, even on cloudy days. Open window shades in your home. Exercise regularly and eat a healthy diet, one low in simple carbohydrates and high in vegetables, fruit, and whole grains. No Known Cause Researchers at the New York State Psychiatric Institute at Columbia Researchers have not pinpointed what causes SAD. There is some University suggest using a “dawn simulator,” which gradually turns on evidence pointing to a disruption of a person’s “circadian rhythm” — the the bedroom light, tricking the body into thinking its an earlier sunrise. body’s natural cycle of sleeping and waking. As the days shorten, the People with SAD sometimes find that their symptoms go away when decreasing amount of light can throw off the body’s natural clock, they travel in or move to more Southern latitudes. If possible, plan a triggering depression. Sunlight also plays a role in the brain’s production mid-winter family vacation in a sunny climate. of melatonin and serotonin. During winter, your body produces more As with adults, depression in children can be addressed effectively. melatonin (which encourages sleep) and less serotonin (which fights “Depression is very treatable with medication and therapy,” says Dr. depression). Researchers do not know why some people are more Spratt. “There are several evidence-based studies showing that cognitive susceptible to SAD than others. 28 Healthy Children Winter 2008
Slide 26: behavioral therapy is effective in treating depression in kids.” For severe cases of SAD in adults, several treatment options exist. The most common treatment is light therapy. Patients sit for up to three hours in front of strong light boxes or wear light visors, with UV rays filtered out. However, light therapy is not recommended for children, says Dr. Spratt. “I know of no evidence-based studies showing light therapy to work for children, and I have never recommended it for children,” she says. patients. “In children younger than 12, only fluoxetine (Prozac) showed benefit over placebo,” she says. Working Through It Together Parents of children with depression should participate in their child’s treatment and recovery. Learn about the disorder and share what you learn with your child. Make sure your child completes his treatment everyday, no matter what form your doctor prescribes. Plan low-key quality time together. Your child won’t have the energy for an arcade, but reading a book or playing a family board game can be fun. Encourage your child to get exercise and spend time outdoors. Plan daily walks together. Fix healthy meals for your family, and establish a set bedtime to ensure he gets enough sleep and the same amount of sleep every night. Your fatigued child will probably need help with his homework. Take time to work through schoolwork together, and communicate your child’s situation to his teachers. Be patient with your child and reassure him that these issues will get better. Whether noticing symptoms of SAD in yourself or depression in your child, take it seriously. Treating this disorder early and diligently can turn the dark days of winter into a pleasant time of togetherness for your family. ● When to Medicate? Left untreated, SAD can lead to serious complications for adults, including suicidal behavior, problems at school and work, and substance abuse. If other treatments prove ineffective, prescription antidepressants may help regulate the balance of serotonin and other neurotransmitters that affect mood. Antidepressants, however, come with a “black box” warning about the risk of suicidal thoughts and behavior. Parents with children on antidepressants need to be vigilant in watching for agitation, anxiety, or insomnia and make sure they continue to see their physician on a regular basis. Dr. Spratt points out that a recent analysis of 27 studies published in the Journal of the American Medical Association found that the benefits of using antidepressant medication to treat major depressive disorder outweighed the risks. But the benefits were more limited in younger Healthy Children Winter 2008 29