American Academy of Pediatrics
Healthy Winter 2008
When It’s More
Than a Cold
Healthy Teeth for
a Healthy Life
How to Have “the Talk” —
and Keep Talking
Waiting Room Copy
Welcome to a new year of Healthy Children. This issue begins our second year
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
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
This Just In... The latest parenting news, research,
and health tips from our experts
Cold Shoulder to
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/
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
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
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
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.
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
To submit questions to Healthy Children, send an e-mail to email@example.com
or write to American Academy of Pediatrics, attn: Healthy Children Magazine
141 Northwest Point Blvd., Elk Grove Village, IL 60007
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
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
For more information, visit www.aap.org.
6 Healthy Children Winter 2008
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
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
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
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
When to Call
Children may need treatment if they show
any of the following symptoms:
Great diﬃculty or fast breathing
Gray or blue skin color
Thick nasal discharge that is yellow, green,
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
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, 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.”
Healthy Children Winter 2008 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
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.
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
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
A fever in a
not be taken
lightly but it helps to
know when to take action
and when t let it run its
When to Call the
By Trisha McBride Ferguson Doctor
Your child is younger than 2 to 4 months old and has
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
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
How to take a rectal
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.
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
How To Encourage
By Margie Markarian
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
the long-term consequences of their actions as well.
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
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
Talk theTalk Before
By Keith Ferrell
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
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
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
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/
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
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
By Cari Jackson
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
American Academy of Pediatrics: Tips on Preventing Teen Suicide
National Institute of Mental Health: Depression in Children and
Mental Health America: Children’s Depression Checklist (www.
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
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