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Healthy Children Winter 2008

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The official magazine of the American Academy of Pediatrics. I serve as its managing editor.

The official magazine of the American Academy of Pediatrics. I serve as its managing editor.

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  • 1. American Academy of Pediatrics Healthy Winter 2008 Children RSV When It’s More Than a Cold 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
  • 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
  • 3. American Academy of Pediatrics Healthy Children Winter 2008 2 Welcome Dr. Renée Jenkins, AAP president, welcomes you to AAP’s authoritative American Academy of Pediatrics resource for parents. attn: Healthy Children Magazine 141 Northwest Point Blvd. Elk Grove Village, IL 60007 3 Table of Contents healthychildren@aap.org 4 This Just In … The latest parenting news, research, and health tips from AAP Editorial Advisory Board our experts Tanya Remer Altmann, MD, FAAP Westlake Village, CA 6 Ask the Pediatrician Answers to common questions Laura A. Jana, MD, FAAP Omaha, NE Jennifer Shu, MD, FAAP 8 RSV: When It’s More Than Atlanta, GA Just a Cold Robert W. Steele, MD, FAAP Sometimes those “cold symptoms” aren’t symptoms of a cold, but of Springfield, MO another type of infection — RSV. Learn more about this virus and how Paul R. Stricker, MD, FAAP to keep it at bay. San Diego, CA 12 Chillin’ with Safety American Academy of Pediatrics As children stay active during the cold winter months, remember Executive Director that safety should be just as much of a priority as when the weather Errol R. Alden, MD, FAAP warms up. Associate Executive Director Roger F. Suchyta, MD, FAAP 16 Good Reasons to Smile Director, Department of Marketing and Publications Good oral health is an important part of good overall health. Here’s Maureen DeRosa, MPA what you need to know to start your children on the path of dental Director, Division of Product Development care while they’re young. Mark Grimes Manager, Consumer Publishing Carolyn Kolbaba 20 Fever Without Fear Fever can signal a number of possibilities about a child’s health. When Manager, Patient Education Regina Moi Martinez is it time to call the doctor? Coordinator, Product Development Holly Kaminski 22 Positive Parenting: Manager, Consumer Product Marketing and Sales Kathleen Juhl 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 For advertising information, please contact: to do just that. Cindy Reed Vitality Communications 24 Adolescent Sexuality: Talk the Talk (336) 547-8970, ext. 3355 Before They Walk the Walk Healthy Children is published by Vitality Communications Is there a more awkward teen topic than sexuality? Just because it’s 407 Norwalk St., Greensboro, NC 27407 | (336) 547-8970 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 27 Winter Blues Sometimes depression follows a seasonal pattern. How can you tell Creative Director . . . . . . . . . . . . . . . . . . . . . . . . . . . Jan McLean the difference between depression and seasonal affective disorder Production Director . . . . . . . . . . . . . . . . . . . . . . . . . Traci Marsh (SAD)? Can it affect your child? Find out here. 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 The American Academy of Pediatrics would like to thank advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. for its sponsorship of this issue of Healthy Children. Publication of an advertisement in Healthy Children neither constitutes nor implies a guarantee or endorse- ment 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. Healthy Children Winter 2008 3
  • 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 The infant cough and cold medicines based on adult data and thus may be inaccurate for children. that have been withdrawn are: The following are a few things parents should know about using Dimetapp Decongestant Plus Cough Infant Drops cough and cold products. (For a complete list, visit www.aap.org/new/ kidcolds.htm) Dimetapp Decongestant Infant Drops Do not give cough and cold products to children younger Little Colds Decongestant Plus Cough than 2 years old unless your healthcare provider specifically Little Colds Multi-Symptom Cold Formula directs you to. Do not give children medicine that is packaged and made for Pediacare Infant Drops Decongestant (containing pseu- adults. Use only products marked for use in babies, infants or doephedrine) children (sometimes labelled “for pediatric use”). Pediacare Infant Drops Decongestant & Cough If your child is taking other OTC or prescription medicines, (containing pseudoephedrine) make sure your healthcare provider reviews and approves their Pediacare Infant Dropper Decongestant (containing combined use. phenylephrine) Read and follow the directions in the “Drug Facts” box. Do not Pediacare Infant Dropper Long-Acting Cough give a child medicine more often or in greater amounts than is stated on the package. Be sure you know the active ingredients Pediacare Infant Dropper Decongestant & Cough (con- taining phenylephrine) and warnings. For liquid products, use the measuring device (dropper, dosing Robitussin Infant Cough DM Drops cup, or dosing spoon) that is packaged with each different Triaminic Infant & Toddler Thin Strips Decongestant medicine and is marked to deliver the recommended dose. Triaminic Infant & Toddler Thin Strips® Decongestant A kitchen teaspoon or tablespoon is NOT an appropriate Plus Cough measuring device for giving medicines to children. If a child’s condition worsens or does not improve, stop using Tylenol Concentrated Infants’ Drops Plus Cold the product and immediately take the child to a healthcare Tylenol Concentrated Infants’ Drops Plus Cold & Cough provider for evaluation. 4 Healthy Children Winter 2008
  • 5. New Nasal Flu Vaccine Youth Suicide for Toddlers Rates Increase The U.S. Food and Drug Administration (FDA) recently approved The suicide rate among young people ages 10 to 24 expanded use of the nasal influenza vaccine FluMist in healthy people rose 8 percent from 2003 to 2004, marking the largest between the ages of 2 and 49 who are not pregnant. single-year increase in more than 15 years, according to a Previously the vaccine, which is sprayed in the nose, was limited to healthy report recently released in the Centers for Disease Control children 5 years of age and older and to adults up to age 49. and Prevention’s Morbidity and Mortality Weekly Report “The goal of preventing influenza is now more attainable with the (MMWR). availability of FluMist for younger children,” said Jesse L. Goodman, M.D., During the 12-month period, suicide rates rose from director, FDA’s Center for Biologics Evaluation and Research. “This approval also 6.78 to 7.32 per 100,000. This increase follows a decline offers parents and health professionals a needle-free option for squeamish of more than 28 percent between 1990 and 2003, when toddlers, who may be reluctant to get a traditional influenza shot.” rates fell from 9.48 to 6.78, the report stated. FluMist should not be administered to anyone with asthma or to children “We don’t yet know if this is a short-lived increase or younger than age of 5 years who experience recurrent wheezing because of if it’s the beginning of a trend,” said Ileana Arias, M.D., the potential for increased wheezing after director of the National Center for Injury Prevention and receiving the vaccine. Children allergic Control at the Centers for Disease Control and Prevention to any of FluMist’s components, (CDC). “Either way, it’s a harsh reminder that suicide and including eggs or egg products, suicide attempts are affecting too many youth and young should also not receive the vaccine. 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 at rates similar to those for people ages 50 to 64. This emphasizes than 200,000 hospitalizations in the United States each year. In addition, the need for improved flu prevention efforts for America’s youngest the disease results in more than $87 billion of U.S. economic burden generation. annually. While the CDC also recommends an annual flu vaccination for During the 2005–06 flu season, only one in five children ages 6 almost everyone who desires protection from influenza, it’s especially months to 23 months were fully vaccinated, and little more than one important for high-risk populations. High-risk groups include pregnant in 10 children needing two doses received both. Flu vaccine coverage women, schoolchildren, people with chronic medical conditions, varied widely among states, but no state had more than 40 percent of people older than 50, health care professionals, and all others in close children fully vaccinated. contact with these high-risk populations. This is particularly important Alarmed at low influenza vaccination rates in both adults and for those in contact with infants younger than 6 months, who are too children, the Centers for Disease Control and Prevention (CDC), the young to receive influenza vaccine, and includes parents, grandparents, National Foundation for Infectious Diseases (NFID), and other leading siblings, and child care providers. health organizations are increasing their efforts to urge Americans to be “Not only does annual influenza vaccination help protect yourself, immunized against the flu this winter. it also helps create a ‘cocoon of protection’ for those around you,” The CDC and the American Academy of Pediatrics recommend that said William Schaffner, M.D., vice president of the NFID. “Vaccination is all children ages 6 months to 59 months receive a vaccination to protect the best way to prevent influenza from infecting yourself and others, against the contagious respiratory infection. Studies have shown that including family, friends, schoolchildren, and co-workers — and is the children younger than 5 years were hospitalized for flu-related reasons right thing to do for your community this and every influenza season.” Healthy Children Winter 2008 5
  • 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
  • 7. come into direct contact with people’s skin. 2. A Pajama Party Wash soiled sheets, towels and clothes in hot water and dry Q: I have eight nieces and nephews all younger in a hot dryer. than 5 years old and wanted to give them all similar gifts for their birthdays. I decided to give each of If a wound appears to be infected, take your child to a pediatrician. them a pair of pajamas, but I had no idea there were Treatment may include draining the infection and antibiotics. so many safety considerations. Can you offer some advice on purchasing sleepwear? 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-flame- resistant 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. Q: My husband and I are preparing a nursery for our first child. Should we put bumper pads in 3. Spreading the Word on MRSA the crib? Q: What is MRSA? How can I protect my three A: Although bumper pads are a nice decorative touch that are teenagers against it? 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 A: MRSA (methicillin-resistant Staphylococcus aureus) is a them outweighs their benefits. bacterium that causes infections on the surface of the skin or Pediatric researchers from the Washington University School of can go into the soft tissue to form a boil or abscess. MRSA has Medicine in St. Louis reviewed three U.S. Consumer Product Safety become a significant public-health concern because the bacterium Commission databases for deaths related to crib bumpers and has become resistant to many antibiotics, making the infections crib-related injuries from 1985 to 2005. They found that 27 children difficult to treat. from 1 month to 2 years old died from suffocation or strangulation Once limited to hospitals, medical centers, and nursing homes, related to the bumper pads or their ties. They also found 25 non- MRSA (also called staph infection) is now commonly spread in fatal infant injuries attributed to bumper pads. schools, dormitories, military barracks, households, correctional “Many infants lack the motor development needed to free facilities, and day care centers. Community-associated MRSA is often themselves when they become wedged between the bumper spread in crowded areas, through skin-to-skin contact, from cuts and pad and another surface,” said Bradley Thach, M.D., professor of abrasions from contaminated items and surfaces. pediatrics and staff physician at St. Louis Children’s Hospital. “They The best ways to protect your children from getting MRSA at are likely to suffocate because they are rebreathing expired air or school or other public places include: their nose and mouth are compressed.” Practice good hygiene. Make sure they keep their hands Thach recommended that parents not use bumper pads in cribs clean by washing them with soap and water or using an or bassinets. “I don’t think bumper pads are doing any good,” he alcohol-based hand sanitizer and showering immediately said. “Although the deaths and injuries may be rare events, they are after participating in sports or activities. preventable by eliminating the use of bumper pads.” 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
  • 8. RSV When It’s More 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 By Tracy A. Mozingo 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
  • 9. Healthy Children Winter 2008 9
  • 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 children who have heavy scarring of the lungs because they were on a to steer clear of anyone who has obvious symptoms of a cold as much as respirator at birth. The antibodies help reduce the likelihood of the child you can. developing pneumonia and can therefore prevent a hospital stay. “These Because RSV is so infectious, it spreads easily and quickly at shopping injections are technically engineered, very expensive, and not for every malls, child care centers, and schools. Many times, younger children are child. But they can make at-risk babies far less sick than they would be infected because an older child brings the virus home. If one child comes otherwise,” says Dr. Bradley, who is also a member of AAP’s Committee down with the virus, it is best to separate the child who has symptoms on Infectious Diseases.. from others until the symptoms subside. Because RSV is a virus rather than a bacterial infection, it cannot be If at all possible, parents of premature or very young infants and treated with antibiotics, and there is no vaccine available yet. “A vaccine is parents of children with a health condition that affects the lungs, heart, or in the laboratory stage, but we probably won’t see anything in human immune system should keep their children away from child care centers trials for the next couple of years,” Dr. Bradley explains. “And because during the peak of RSV season. even natural infection with the virus does not provide perfect immunity “Those with RSV can shed the virus for as long as a week,” says Dr. from getting RSV again, a vaccine will most likely not provide perfect Bernstein, a member of the American Academy of Pediatrics (AAP) immunity either.” Committee on Infectious Diseases.. “That makes it necessary to keep the So what’s a parent to do with a child suffering from RSV? Here are infected separated from those who have no symptoms for quite some some guidelines: time.” Give plenty of fluids. Also, steer clear of tobacco smoke. “Avoiding smoking is key,” Dr. Use a cool-mist vaporizer during the winter months to keep the air Bernstein emphasizes. “Parents who smoke are more likely to acquire viral moist. (Be sure to clean the vaporizer regularly.) respiratory infections and then pass them on to their children.” Blow little noses frequently (or use a nasal aspirator for infants). Give non-aspirin pain reliever, such as acetaminophen. Aspirin should Diagnosis and Treatment not be used because it has been linked to Reye syndrome, a disease that If a child is otherwise healthy, there is really no need to obtain a formal affects the brain and liver. RSV diagnosis. The condition will generally run its course without specific medical treatment. If your child is at higher risk as a premature Knowing how to avoid spreading the virus can help keep your children infant or because of other medical conditions, then a doctor can diagnose healthy. And recognizing the symptoms that signal greater inflammation RSV by taking a swab of nasal fluids. can prevent a trip to the hospital for those a higher risk. The good news is Doctors can also decide which young or premature infants might that the majority of children who come in contact with RSV will never benefit from RSV antibodies during the peak season. This would likely be know they had anything more than just a “bad cold.” ● 10 Healthy Children Winter 2008
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  • 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 S o your young ones survived summer — open water, sunburn, Even though it might seem odd, you can get sunburn in the winter. mosquitoes, ticks, and all — thanks in no small part to the safety The sunlight reflects off snow and ice. Wear sunscreen with an SPF 15 precautions you took. Now they’re looking to get ready for winter minimum and cover exposed areas of the body. You should wear sports. What should you do to help them prepare? protective eyewear and an SPF lip balm, Benjamin says. 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. Safety in Layers Physical activity should be a healthy part of your family’s routine When thinking about outside activity, think about clothing, too. throughout the year. And safety should always be a central part of your Layering is a good idea; so are moisture-wicking fabrics and clothing children’s recreational fun. 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), Fun in the Winter Sun so hypothermia can occur more easily. “Kids can sweat, too, when they’re It’s true that many safety concerns are the same regardless of season, warm,” says Dr. Benjamin. And that sweat can chill them quickly when it says Holly Benjamin, M.D., FACSM, FAAP, the director of primary care gets exposed to the cold air as they remove layers. sports medicine program at the University of Chicago Student Care “I think with winter sports safety, especially with kids, the temperature Center. For starters, parents still need to remember sunscreen, for and the environment are near the top of the list in importance. And I example. “People come back from ski trips and we actually treat a fair think that parents have to be really proactive and responsible about number of sunburns,” she says. dressing them appropriately in layers, covering their heads and necks.” Chillin’with Safety Healthy Children Winter 2008 13
  • 13. Watch out for fashion trends that could land you in the ER. Long fractures — commonplace in snowboarding — can be prevented by scarves and cords can get caught in sled blades, and hoods can block simply using wrist guards. peripheral vision, she says. “Some people believe that it’s safer to just have Safety is key in ice hockey or sports involving equipment, Dr. Benjamin a hat, neck warmer, a warm jacket and gloves,” she says. As long as the says. “The biggest challenge with kids is fit, making sure everything fits exposed skin is covered and the jacket can be zipped, your child should be properly and is the right size. And that changes. No one wants to buy new ready for winter play. 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. Stay Alert Look at the laces, for broken blades and make sure the leather on hockey Injuries can happen anywhere, anytime. Dr. Benjamin’s advice follows and ice skates isn’t too broken down around the ankles. Follow the team that of the American Academy of Pediatrics (AAP): Be aware and use guidelines, too. If you need a mouth guard, wear one. caution. Children should always wear helmets while sledding, skiing, “A piece of used equipment that fits well and is in good condition is snowboarding, and playing ice hockey, for example. 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 You have to check all equipment, new and old, to see that it fits. You need kids, they’re not always looking for trees or rocks, so you have to scope out to check it to make sure it’s still safe or not broken. If it gets used a lot, it the environment and make sure they have a clear path,” she says. may not hold up. Make sure helmets and boots are sized correctly. Make Parents should also make sure that the hill your children are sledding sure the equipment is in good shape. If you’re concerned, ask a sales down doesn’t empty onto a pond that might not be frozen solid, she says. person at a ski shop, 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 Skills Assessment into each other or knock people off is obviously a setup for injury.” If it’s a new activity, work to master your skills, she says. Play it safe by “It’s fun for kids to enjoy winter sports,” Benjamin says, “and we’re fully starting with a snowboarding lesson before you hit the slopes. supportive of kids participating in winter activities as long as they follow It’s recommended, appropriate and safe, she says, to start slow or on a safety guidelines.” 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 Equipment Check more than you’re ready for. If you’re planning a skiing or snowboarding trip, have the equipment By taking a few precautions, you can make sure that your children get fitted by a professional. A child in too-large boots can trip and fall. A child the healthy benefits of winter exercise without taking unnecessary risks. ● in skis that aren’t the right size can fall, too. And keep in mind that wrist 14 Healthy Children Winter 2008
  • 14. 16 Healthy Children Winter 2008
  • 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 D 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. 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
  • 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 The Golden Rules morning. Later that same day, the child fell and for Raising Cavity-free Kids pushed her teeth up into her gums. Support good dental health by taking care of your child’s gums and “It is not uncommon for a toddler to fall and teeth on a daily basis. Once the child is old enough to “do it by herself,” have dental trauma when learning to walk. In the scenario where the child already has a dental continue monitoring daily habits and self-care. home at age one, that family knows where to go Be selective about any type of beverage you put in your child’s bottle for help,” says Dr. Keels. “In the scenario where or sippy cup besides water. Remember, dentists often refer to juice and they have not seen a dentist yet, it will be doubly soda as “liquid candy.” stressful to find a provider.” Keep a bottle or sippy cup away from your child’s naptime and Finding the Right Dentist nighttime slumbers. Liquids tend to stick to the teeth because the David M. Krol, M.D., FAAP, associate professor mouth is drier during sleep. 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 “wholeheart- candy. Sugary foods leave behind a sticky coating that converts to edly” supports an oral health risk assessment by one year of age. It’s the best way to build harmful bacteria and enamel-eating acid. But if you feel compelled knowledge about how to care for a child’s teeth, to give your child an occasional sweet, choose one that melts rapidly and to build the good habits that are key to instead of gummy candy. 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 dentist,” Dr. Krol points out. healthy teeth. Build good habits early by giving Experts suggest that you approach locating a your child healthy treats in place of sweets at pediatric dentist with the same seriousness and snack time. 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 The Exam: What to Expect receives an additional two to three years of specialized training over that Almost all pediatric dentists will perform a thorough exam of the of a non-specialized dentist. And while maintaining a toy-filled waiting mouth and teeth while the child is comfortably situated on the parent’s room might not be necessary to obtaining credentials, it most certainly is lap. Using a lap pillow as a prop, some dentists may have the child lean the norm. ● 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
  • 17. [ Newborns A fever in a newborn should not be taken lightly but it helps to Fever know when to take action and when t let it run its to course. Without Fear When to Call the By Trisha McBride Ferguson Doctor Your child is younger than 2 to 4 months old and has a fever. L et’s face it, fevers can be scary for parents. But even though infants get their share of colds and fevers, fevers should be Your child is lethargic, unresponsive, refuses to eat, taken more seriously. When your baby is burning up, it can has a rash, or is having difficulty breathing. be hard to think straight and make important decisions. You observe signs of dehydration, such as a dry Learning what causes fevers and how to treat them will ease your anxiety and help you take control of the situation. mouth, a sunken soft spot, or significantly fewer wet diapers. What causes a fever? Your child’s fever lasts more than a few days. “Fever is usually, but not always, an indication of some infection in the body,” explains Dennis Vickers, M.D., FAAP, chairman of Your child experiences a febrile seizure (see “Febrile pediatrics at Sinai Health Systems in Chicago. “It is the body’s first Seizures” sidebar for explanation). 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, Managing the Fever plus or minus about 0.6 degrees). When the body detects an infection or A fever can’t always be detected by feeling your infant’s forehead. It’s other illness, the brain responds by raising the body temperature to help usually necessary to take his temperature as well. Although there are fight the condition. numerous thermometers on the market that measure temperature in “Any rectal temperature over 100.4 is generally considered a fever,” says different areas, parents should use rectal thermometers with their babies Barbara Huggins, M.D., FAAP, professor of pediatrics at the University of for the most accurate reading. “The ‘gold standard’ measurement is still Texas Health Center at Tyler. “A fever itself doesn’t necessarily warrant a the rectal temperature,” says Dr. Vickers. call to the doctor. It depends on the age of the child and his other Once you’ve identified a fever, you can begin treating it if needed based symptoms. on your child’s age and other symptoms. While you may instinctively 20 Healthy Children Winter 2008
  • 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. Febrile Seizures What are they? Here are the steps for taking a rectal temperature: A febrile seizure is a relatively common and 1. Use a rectal thermometer (preferably digital) that harmless side effect of fevers in young children. has a round bulb at the end. 2. Clean the tip of the thermometer with rubbing alcohol or soap and water. What does it look like? It’s a full-body seizure where your child may be 3. Lubricate the tip with a water-soluble lubricant. unresponsive, look strange, twitch, stiffen or roll 4. Place your baby on his stomach across a firm surface his eyes. or your lap. Or, if your child is more comfortable on her back, gently lift her legs and proceed to step 6. What should you do? 5. Stabilize your child by placing one hand on his lower Remain calm and move your child to a safe place back just above the buttocks. If your child is where he can’t hurt himself. Do not put anything wiggling, ask someone to help you restrain him. in his mouth. Febrile seizures usually last less 6. Slowly insert the lubricated thermometer into the than one minute, but can last up to 15 minutes. anal opening about one-half inch, stopping if you Call 911 if the seizure lasts longer than a few feel any resistance. Never force the thermometer. minutes. Follow up with your pediatrician for all 7. Gently hold the thermometer in place between your febrile seizures. 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. want to bring your child to the doctor’s office, it may not be necessary, giving the appropriate dose,” advises Dr. Huggins. “Refer to the label and especially if the child seems fine once the fever is reduced. if they’re under two years old, contact your pediatrician or pharmacist.” “What I tell parents when they call me in the middle of the night is, Common sense is equally important for treating fevers, says Dr. ‘Don’t panic.’ Fever by itself is not something to panic about. I ask them Vickers. “Use your head. Don’t overdress the child, no matter what how the child looks and how they’re acting — are they behaving grandma says.” The same goes for giving baby an alcohol bath, an old normally?” says Dr. Huggins. “Then we focus on how to get the fever practice that is no longer recommended. down. With the vast majority of viral infections, once you get the fever A fever will also cause a child to lose fluids more quickly, so offer your down, everything’s better.” baby plenty of fluids to avoid dehydration. Signs of dehydration include crying without tears, a dry mouth, and fewer wet diapers. Keeping Fever at Bay Being prepared can help take the fear out of fever. Keep your digital Although not every fever needs to be treated, there are some things you thermometer ready and accessible so you don’t have to search for it once can do to help make your child more comfortable. Giving a child your child is ill. Have children’s acetaminophen or ibuprofen on hand. acetaminophen or ibuprofen will usually reduce a fever. “Make sure you’re And make sure your pediatrician’s phone number is handy. ● Healthy Children Winter 2008 21
  • 19. [ Children How To Encourage Good Behavior Positive Parenting By Margie Markarian W hether it’s sneaking a snack before dinner, refusing to Quality Time finish up a video game, or whining all the way to the In spite of busy lifestyles, it’s also important to spend quality parent- mall, misbehaving is an inevitable part of childhood. child time together each day. “Even if it’s only five, 10, or 15 minutes, It’s no secret that effective parenting involves knowing children are looking for attention and need some special time,” says Dr. how to respond when kids act up and steering clear of Vickers. Even when the number of spare minutes in your day is scarce, meltdown situations. It also means setting limits so kids know when they remember that quality time “… goes a long way in keeping children from are crossing the line between acceptable and unacceptable behavior. using negative behavior to get your attention.” “The gentlest way to set limits is to establish routines and rules so that Family meals and bedtime stories are ideal opportunities for parents children know what’s expected of them,” says Pamela C. High, M.D., and children to catch up and connect in positive ways. “But doing FAAP, and director of developmental-behavioral pediatrics at Hasbro different things on different days works, too,” acknowledges Dr. High. The Children’s/Rhode Island Hospital in Providence. “When children are point is to be focused on your child, which can happen whether the two young, the easiest kinds of limits to set are the ones about safety, like of you are chatting during a walk to the store, making dinner together, ‘Don’t touch the stove’ and ‘Hold my hand when you cross the street.’” playing a board game, or high-fiving each other after a soccer match. Good Rules, Good Rewards Measuring Discipline As kids get older and the situations they face become more varied, For those unavoidable times when kids need discipline, consider the parents tend to have more ambivalence about rules, says Dr. High, who is following approaches to doling out punishment: also a professor of clinical pediatrics at Brown University’s Medical Establish logical consequences. To the degree possible, the School. Nonetheless, rules about no TV until homework is done and consequence of any misdeed should relate to the offense in a sensible, being in pajamas and ready for bed by 8:15 on school nights has a way of easy-to-understand way. For example, if your kids are fighting over a warding off conflict. toy after you’ve given them the chance to work things out, simply take “Children want to know the boundaries and what the rules are,” says the toy away for 24 hours and then let them try again. Similarly, if your Dennis Vickers, M.D., FAAP, chairman of pediatrics at Sinai Children’s son “forgets” to wear a helmet when he’s riding his skateboard, help Hospital in Chicago. “Discipline is really more about guiding children him to “remember” by not letting let him ride the skateboard for at toward positive behavior than it is about punishment.” least the rest of the day. Both pediatricians recommend adopting a parenting style that Take away privileges. Sometimes it’s not possible to come up with an encourages and recognizes good behavior with words, smiles, and hugs. appropriate consequence. That’s when withholding privileges becomes They also urge parents to get in the habit of catching their children doing an effective strategy. Just be sure to take away a privilege your child things right. deems valuable and isn’t a basic need. Children above the age of 4 or 5 “Noticing and complimenting kids for hanging up their jackets, setting understand it when you tell them: “You can’t have a friend over this the table, and keeping a baby brother amused while you cook supper weekend because you didn’t do your household chores” or “You won’t reinforces the types of positive behavior you want to see again and again,” be able to watch the your favorite TV show tonight because you says Dr. High. 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
  • 20. Discipline No-Nos the long-term consequences of their actions as well. for Parents Call for a timeout. Timeout remains a tried-and-true No hitting or spanking. Physical force hurts and teaches kids that discipline tool for escalating behavior problems because it violence is an acceptable way to show anger and solve problems. removes attention from the negative behavior. They are The American Academy of Pediatrics strongly opposes striking especially helpful in calming tantrums and defusing a child. aggressive behaviors (biting, hitting, throwing), as well as for responding to willful disobedience, back-talk, interrupting, No labels. A child may exhibit “bad behavior,” but a child should and sometimes whining. Experts agree that timeouts should not be called a “bad boy” or a “bad girl.” last one minute for each year of life up to age 11 or 12. No unreasonable expectations. Expect your child to test limits, Timeouts should take place in a safe, boring home location and recognize that it is your job as a parent to consistently (and as that is free from entertaining distractions and does not frighten your child in any way. When the timeout is over and calmly as possible) teach consequences. Avoid situations that invite you and your child have both calmed down, explain why the meltdowns and keep your child’s age, temperament, and maturity behavior was unacceptable and move on. Remember that level in mind as you go through the course of the day. If, for your ultimate goal isn’t to separate your child, but to give example, you know your child is tired and hungry, then don’t him a little time to calm down and then re-engage in what’s expect perfect behavior at the supermarket. going on around him. 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 Ultimately, the best way to encourage good behavior is to lay the groundwork early by being a good role model and to give in and buy the toy later. Kids quickly learn that you’re not demonstrating a consistent, loving approach to discipline. true to your word, and will take advantage by not complying with It’s also important to have patience and maintain a flexible your requests. attitude, because there are always going to be times when Avoid inconsistencies. You may feel one way, your spouse might kids are being annoying but not really doing any harm. And, feel another way, but back each other up in your child’s presence. as Dr. Vickers points out, “It’s okay to let little things stay Then, discuss your different approaches privately. “When you don’t little things.” ● present a united front, children figure it out very quickly and Margie Markarian is a freelance writer in Franklin, capitalize on it,” says Pamela C. High, M.D., FAAP, and director of Massachusetts. She specializes in writing about health, parenting, developmental-behavioral pediatrics at Hasbro Children’s/Rhode and family life. Island Hospital in Providence. Healthy Children Winter 2008 23
  • 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
  • 22. Adolescent Sexuality Talk theTalk Before TheyWalk theWalk By Keith Ferrell A dolescence can be tough enough to get through them out on their own. We hold their hands. We educate them without questions of sex, sexuality, and sexual about the risks. And we trust them with increasing responsibility identity. But adolescents are humans, too — no only as they’re old enough and show they’re ready to handle it.” matter how alien they may seem to their parents at “The media particularly and everything around us talks about times. Openly addressing the all-too-human sex,” adds Dr. Seigel. “It’s hard to avoid it.” questions of sexual development, sexual desire, and the nature of The only foolproof approach to sexual safety, of course, is to the adolescent’s developing sexual identity are critical. Sharing say “no” and defer sexual activity until later in life. The good factual information with and giving good moral guidance to news is that as many as half of all adolescents do just that. But your teenager is a vitally important part of helping your teen that leaves the other half at risk — many of them engaging in understand herself or himself. It can help your child avoid unprotected sex, exposing themselves to potentially grave disease devastating, and possibly life-threatening, errors in judgment. and unwanted pregnancy. “Above all, it is critical that parents be truthful, honest, and “The most important thing to teach your child is available to their children,” says Charles R. Wibbelsman, M.D., responsibility,” Dr. Seigel says. “Discuss how to make decisions FAAP, Chief of Adolescent Medicine at Kaiser Permanente in San and understand what the consequences of decisions will be. You Francisco and a member of the American Academy of Pediatrics’ can start by discussing decisions and consequences that don’t Committee on Adolescence. involve sex, and then move the conversation toward sexuality. “Parents often have their own agenda — don’t do this and After all, there are consequences to having sex or not having sex, don’t do that. But they need to take a step back and leave the and every child is going to get a lot of misinformation along the judgments aside for this discussion,” says Warren Seigel, M.D., way from their peers and the media.” FAAP, Chairman of the Pediatrics Department and Director of The pressures upon children — from peers and also the Adolescent Medicine at Coney Island Hospital, Brooklyn, N.Y. media as mentioned above — may actually offer one of the most “The most appropriate and important thing for a parent and a effective pathways to opening what must be an ongoing dialogue child or adolescent in dealing with questions about sexuality and about sex and sexuality, not a single talk or lecture. What to do, sexual health is an open channel of communication.” then? It’s good to turn these encounters with the media into teachable moments. The Messages They Get “Seeing something in the media that is obviously sexually In today’s hyper-sexualized culture of Internet sites, mass charged can be a springboard for conversation between media entertainers, and 24/7 programming, the traditional adolescent and parent,” says Dr. Wibbelsman. “Is the ad bad or “birds and bees” lecture (or pamphlet handed to the child to read good? What’s the ad trying to say? Use this moment as an on her or his own) on reproductive basics is completely opportunity to teach and encourage, not to pronounce a harsh, inadequate. Carefully preparing children for the normal changes dismissive judgment. By engaging the child and building his in their bodies as well as the endless assault of peer pressure, self-esteem and her confidence in her ability to make judgments, media glorification of irresponsible sexuality, and advertising you’re showing him that you respect what he’s learning and how come-ons is the only way to create a sense of security for parents she’s growing in her decision-making.” and children alike. After all, however adult their appearance, behavior, and “There are a lot of things in the media that are not appropriate attitudes may appear, adolescents remain closer to childhood for a particular age,” says Dr. Wibbelsman, who is co-author of than adulthood, and children need ongoing parental guidance to The Teenage Body Book and Growing and Changing. “We don’t prepare for adulthood. “I know it’s a lot of work, but parents put children on the street and wish them luck before sending need to monitor what their children see and be there, available to Healthy Children Winter 2008 25
  • 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 Helpful Resources For more information about talking to your child about human see or hear. And experience with him or her together, sexuality, visit these Web-based resources: so you can discuss it and use it to build trust between you.” The American Academy of Pediatrics: aap.org/healthtopics/ sexuality.cfm Starting the Discussion The Mayo Clinic’s Teen Health section: So when is the right time to start talking about sex with your child? It’s a good idea to start laying the www.mayoclinic.com/health/sex-education/CC00032 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 open such discussions are likely to be as you both grow Nemours Foundation: 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 your adolescent: ‘This is really hard for me to talk • Abstinence (kidshealth.org/teen/sexual_health/ about, and it was hard for me to talk about with my contraception/abstinence.html) dad when I was your age.’ But it’s important to talk about, and we have to talk about embarrassing things sometimes.” Keep reminding your child that you are in her corner every step of the “Helpful Resources” at the top of this page for reliable resources of way. “Never let them forget that your love is unconditional,” Dr. Seigel information on these subjects.) 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 Keeping the Channels Open at the same time, let the adolescent know what your views and values As your child matures — physically, mentally, and emotionally — are. Know the difference between facts and your opinion, and be clear opportunities will emerge for making regular discussions about sexuality about both.” part of your continuing conversation. Obviously, changes in your child’s But how to do it in a way that helps keep the channels open? It’s a body as puberty begins are crucial markers for such conversations. four-letter word, actually. “The key is to let adolescents know that you One area that should receive particular attention is “urban myths” — love them no matter who they become,” Dr. Seigel says. “They may bits of false information that “everyone” knows, passed along from turn out tall, short, heavy, thin, healthy, or sickly — but you’ll love adolescent to adolescent (and even from generation to generation: Don’t them no matter what, no matter what decisions they make. That is much be surprised to find that your child has heard some of the same myths easier said than done for many parents, but that’s key to raising a and misinformation that circulated during your adolescence). Make healthy adolescent.” clear, for instance, that oral sex is not without risks, that unprotected And don’t hesitate to discuss values, morals, and ethics with regard to intercourse without ejaculation is not effective birth control, and so on. sex — without lecturing, but with guidance. By providing your child “It’s very important to get the facts straight from the start, and share with a solid framework of information and values, you’ve taken a large those facts with your child,” says Dr. Wibbelsman. “That builds trust, step toward making sure that when he or she becomes sexually active it and that trust is critical to guiding your adolescent through these will be with the knowledge, preparation, and maturity that will mark the challenging times.” transition to sexual activity as an informed choice, not a risky accident. ● 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
  • 24. [ Home Health By Cari Jackson D epression can b a serious problem f adults and children alike. i be i bl for d l d hild For some children, the 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 change in season brings with it a shift newly developed bad attitude could actually be a case of depression in mood. Is it a passing phase, or or, in some instances, Seasonal Affective Disorder. Seasonal Affective Disorder (SAD) — often referred to as “winter something more serious? Here’s what depression” — is a subtype of depression that follows a seasonal pattern. The you need to know about depression, most common form of SAD occurs in winter, although some people do experience symptoms during spring and summer. SAD, and your child. 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.” Healthy Children Winter 2008 27
  • 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-s- A Season’s Symptoms depression-checklist) SAD usually develops in a person’s early 20s, and the risk for the disorder decreases as you get older. Nemours Foundation: Understanding Depression (kidshealth.org/ SAD is diagnosed most often in young women, but parent/emotions/feelings/understanding_depression.html) 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. As winter approaches, 10 to 20 percent of us begin to suffer mild “In general, SAD is a better-recognized disorder in adults because so 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 winter progresses. determine whether a child is suffering from depression or anxiety first, 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, They may become depressed and irritable. Eventually, they are no longer hypoglycemia, or mononucleosis. Doctors can administer questionnaires 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 on the ability to be an effective parent. like ‘sad mood’ or ‘feeling blue,’” says Dr. Spratt. She points out that one Children and adolescents can also suffer these symptoms. They may of the most telling markers of depression in children is anhedonia — experience feelings of low self-worth and hopelessness. Children with which means “absence of pleasure.” “So a good screening question to ask depression struggle to concentrate on their schoolwork. Their grades children is, ‘When was the last time you had a really good time?’” 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 No Known Cause carbohydrates and high in vegetables, fruit, and whole grains. Researchers have not pinpointed what causes SAD. There is some Researchers at the New York State Psychiatric Institute at Columbia evidence pointing to a disruption of a person’s “circadian rhythm” — the University suggest using a “dawn simulator,” which gradually turns on body’s natural cycle of sleeping and waking. As the days shorten, the the bedroom light, tricking the body into thinking its an earlier sunrise. decreasing amount of light can throw off the body’s natural clock, People with SAD sometimes find that their symptoms go away when triggering depression. Sunlight also plays a role in the brain’s production they travel in or move to more Southern latitudes. If possible, plan a of melatonin and serotonin. During winter, your body produces more mid-winter family vacation in a sunny climate. melatonin (which encourages sleep) and less serotonin (which fights As with adults, depression in children can be addressed effectively. depression). Researchers do not know why some people are more “Depression is very treatable with medication and therapy,” says Dr. susceptible to SAD than others. Spratt. “There are several evidence-based studies showing that cognitive 28 Healthy Children Winter 2008
  • 26. behavioral therapy is effective in treating depression in kids.” patients. “In children younger than 12, only fluoxetine (Prozac) showed For severe cases of SAD in adults, several treatment options exist. The benefit over placebo,” she says. 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 Working Through It Together filtered out. However, light therapy is not recommended for children, Parents of children with depression should participate in their child’s says Dr. Spratt. “I know of no evidence-based studies showing light treatment and recovery. Learn about the disorder and share what you therapy to work for children, and I have never recommended it for learn with your child. Make sure your child completes his treatment children,” she says. everyday, no matter what form your doctor prescribes. Plan low-key quality time together. Your child won’t have the energy When to Medicate? for an arcade, but reading a book or playing a family board game can be Left untreated, SAD can lead to serious complications for adults, fun. Encourage your child to get exercise and spend time outdoors. Plan including suicidal behavior, problems at school and work, and substance daily walks together. Fix healthy meals for your family, and establish a set abuse. If other treatments prove ineffective, prescription antidepressants bedtime to ensure he gets enough sleep and the same amount of sleep may help regulate the balance of serotonin and other neurotransmitters every night. that affect mood. Antidepressants, however, come with a “black box” Your fatigued child will probably need help with his homework. Take warning about the risk of suicidal thoughts and behavior. Parents with time to work through schoolwork together, and communicate your children on antidepressants need to be vigilant in watching for agitation, child’s situation to his teachers. Be patient with your child and reassure anxiety, or insomnia and make sure they continue to see their physician him that these issues will get better. on a regular basis. Whether noticing symptoms of SAD in yourself or depression in Dr. Spratt points out that a recent analysis of 27 studies published in your child, take it seriously. Treating this disorder early and diligently the Journal of the American Medical Association found that the benefits of can turn the dark days of winter into a pleasant time of togetherness using antidepressant medication to treat major depressive disorder for your family. ● outweighed the risks. But the benefits were more limited in younger Healthy Children Winter 2008 29

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