Question

My physician prescribed anti-depressant medication for my eleven-year-old. The medicine seems to be helping but I’m worried about getting my child dependent on these drugs. She says she can’t wait to take the medicine to make her feel better. How long do kids usually stay on medication?

Answer

Your doctor made a mistake in not referring you to mental health counseling in addition to prescribing medication. Speak with your physician about your concerns, and ask for a referral to a therapist. Medication can be very helpful in treating childhood depression, but a comprehensive treatment plan has as its goal getting kids off medicine. Cognitive-behavioral therapy is very effective with these children, and helps them learn how to identify and control their feelings without taking drugs.

Question

My teenager tells me she has “flashbacks” of bad things that happened to her when she was younger. I’m not a perfect mom and there were lots of problems when my kids were little. However, my life is back on track and the kids are in a real stable situation. I only hear about these “flashbacks” when I get after my daughter about her grades, cleaning her room, or fighting with her sisters. How can I tell if she is making this up?

Answer

Regardless of whether these reports are real or fabricated, your daughter needs a psychological evaluation, so speak with your family doctor about getting a referral to a mental health professional.

However, you also need to send a very strong message to your teen that past events are not an excuse for her inappropriate behavior. Make sure your rules are clear, specific, and reasonable. Set up consequences that you can readily implement. Perhaps most importantly, be consistent in your follow-through.

It sounds like you’ve made some great changes in your life. That’s a wonderful example to your kids that yesterday’s memories are a record of where you have been and not a road map for the rest of your life.

Question

Help! I know my child needs to see a psychologist, but I have no idea how to get help for him. I’m also very nervous about bringing my child for therapy.

Answer

Speak with your family doctor and ask for a referral. If that doesn’t work, talk with a counselor at your child’s school. Make certain that the therapist has experience and training in working with children your child’s age. Ask to meet alone with the therapist for the first session. Write down specific questions or concerns you have about therapy. Ask the therapist to describe what typically occurs during a session. You’ll get a real good sense after one meeting if this is a good match for you and your child.

Please recognize that counseling is much more than someone talking alone with your child. That typically accomplishes very little. It is essential for you to be actively involved in this process.

Next Week: Who commits sexual crimes against children—-some surprising (and disturbing) research results!

Sleep is very important for you and your children. The best way to enhance good sleep habits is ROUTINE, something we often struggle with in my house.

Our goal for Audrey is that every day after lunch or brunch we get ready for nap time. We have a wind down activity such as reading books, singing songs, or telling stories. We also have been known to use a video or a TV show. However, I can honestly say that if it is a TV show she enjoys, such as Cailou or Dora, she will not go to sleep, but make herself stay bug eyed and plugged into the show. So, we pick one of my old Disney movies or other PBS kids and turn it on for a bit. Our goal is to turn it off within twenty minutes once she has calmed and is drowsy. Since she attends child care twice per week we STRIVE to stay on the same schedule by napping around 1230. Unfortunately life sometimes gets in the way and man do we all suffer at times. She gets whiny and cranky, sometimes has trouble falling asleep because she is overtired. Poor nap time can also disrupt bedtime.

For Ethan things are a bit different since he is still a baby. He is often still taking 2-3 naps daily.  These naps last anywhere from 30 minutes to 2 hours. Jeff is much better then I am. He will often read Ethan’s cue and put him to sleep in his bed. Ethan will fuss for a few minutes and then drift off to sleep. (Don’t forget the ABC’s of safe sleep for infants!)

I however have fostered the terrible habit of nursing Ethan to sleep. If I am at home this is often how he expects to be put to sleep and I often comply. I am currently reading some books on the topic in an attempt to improve all of our sleeping habits at home.

What books have you read that you have found helpful?

So how much sleep should your children strive for?

Here are the general recommendations during a 24 hour period:

Alas, the bedroom door just opened. Nap time is over for today!

My concern – babies can be seriously injured if they fall off a shopping cart.  And it happens – we see kids in our emergency room rather frequently for these injuries. We actually see 1-2 cases a month!

People are always surprised when I give presentations about car seats and mention that car seats are made for traveling – not for sleeping or putting in shopping carts. We see people do it all the time so we think it’s safe – right?

The issue is that infant car seats are not designed to securely fit on top of shopping cart. Most car seat manufacturers specifically prohibit using their seats in shopping carts – but who takes the time (maybe other than me and other car seat nerds) to read the car seat instructions front to back?

Since car seats aren’t designed for shopping cart travel they are often unstable. One good bump of the cart – or even worse – bumper cars in aisle 4 – and baby is on the ground.

My quick fix: Don’t put the car seat on top of the shopping cart!

Okay – I know we have to be realistic as well.  I’ve had to shop with an infant. Here are some suggestions to limit a shopping cart wreck.

• Place the infant seat in the main portion of the cart.  I’ve done this – it’s a great way to limit how much I purchase (you know how thrifty I am). If you have a long grocery list you may need to grab another shopping cart – yes you may look a little silly but I’d prefer looking silly to a trip to the emergency department (especially since I would be visiting my colleagues who read this blog).
• Try to find one of the carts that have a built-in carrier. I’ve found these to be hit or miss.  Some have weight restrictions and if the harness is missing or broken don’t use it.  I would also suggest bringing a light receiving blanket to put under baby – don’t know how often these are cleaned.
• Enroll Dad or another support system! My weekly trip to the grocery store is my quiet time – Dad knows he won’t get fed if I don’t go and the trade-off is that he has kid duty. This way I avoid the problem all together!

Here’s to safe travels down the cereal aisle!

For example, one cup of Golden Crisp cereal contains almost as much sugar as a Snickers Bar.  One cup of Cocoa Krispies or Cap’n Crunch has as much sugar as five Oreo cookies.   Finally, a cup of healthy-sounding Apple Cinnamon Cheerios have the same amount of sugar as a ½ cup serving of ice cream.

According to a 2011 study published in Pediatrics, the journal of The American Academy of Pediatrics, “Compared with serving low-sugar cereals, high-sugar cereals increase children’s total sugar consumption and reduce the overall nutritional quality of their breakfast.”  Children served high-sugar cereals consumed twice the amount of sugar overall at breakfast time, and were significantly less likely to include fruit in their breakfast.

Give your child a healthy start to the day with these four tips for choosing a nutritious cereal:

1. Check out the nutrition facts label Turn your cereal box around and look at the Nutrition Facts label.  A healthy cereal will have at least 3 grams of fiber and less than 10 grams of sugar per serving.  Cereals that meet these criteria include Cheerio’s, Shredded Wheat, Wheaties, Total, Life, and Original Honey Bunches of Oats.
2. Practice portion control In the study mentioned above, children who ate sugary cereal poured themselves an average of two servings in one meal.  To keep your child’s portions in check, try using smaller bowls, or keep a one cup measuring cup in the cereal box for your child to scoop out his or her serving with.
3. Be careful what you top your cereal with If a low-sugar cereal tastes bland to your child, don’t add sugar!  Instead, try fresh or dried fruit for additional color, sweetness, and healthy vitamins and minerals.  Use skim or 1% cow’s milk or light soy milk to keep the fat content low.
4. Become a mix master If your child has difficulty giving up his or her favorite sugary cereal, try mixing it half-and-half with a lower sugar cereal.  For example, Count Chocula has 16 grams of sugar in a 1-cup serving.  By mixing ½ cup Count Chocula with ½ cup Kix, you reduce the sugar to 9 grams.

Reference:  Harris, J. L., Schwartz, M. B., Ustjanauskas, A., Ohri-Vachaspati, P., & Brownell, K. D. (2011).  Effects of serving high-sugar cereals on children’s breakfast-eating behavior.  Pediatrics, 127(1), 71-76.

By: Leah Sabato, MPH, RD, LD has been a dietitian at Dayton Children’s for three years.  She has a passion for working with kids and their families and believes that good nutrition should be easy, tasty, and fun!

The Girl Scouts have always been about a lot more than cookies and cookouts, and have recently revamped their recognition system to reflect the needs of young girls. The Scouts’ merit badges underwent their first major overall since 1987, with one badge in particular being the subject of both criticism and compliments. Scouts in grades six through eight can now earn a “Science of Happiness” merit badge.

This new badge has been described as “cheesy” and “absurd” by some critics. Happiness is a subjective sense of satisfaction that cannot be dissected in a scientific laboratory, and it’s silly to encourage preteen girls for thinking otherwise.

The rationale behind the badge is that wellbeing can be scientifically analyzed like other psychological conditions. Scouts earn the badge by following the scientific method to study their own happiness and that of others. They are involved in such activities as helping others, learning to forgive, reflecting on family memories and events, and keeping a journal of their activities. The focus on preteen girls was intentional, based on data that girls’ wellbeing is severely challenged during adolescence with issues of anxiety and depression.

The critics are wrong on this issue. I applaud the Girl Scouts for trying to integrate psychological research into the lives of young girls at a critical time of their development. Based upon years of research by Dr. Martin Seligman, it is possible to scientifically study the factors that give people a positive sense of well being. Five elements are important:

• Positive Emotion. People with a high sense of well being frequently do things that make them feel good. They are balanced in their pursuit of positive feelings, and weigh the benefits of doing something that feels good immediately (e.g., eating lots of ice cream) with the long-term consequences (weight gain).

• Engagement. Happy people make commitments, and are conscientious in following through with their activities. They feel connected to their jobs, other people, church, and recreational activities.

• Relationships. The quality and quantity of our contact with others are critical factors in determining our well being. Do we surround our lives with people who are positive, funny, ethical, and caring? Do we act the same way towards them? Do we enjoy spending time with our kids, coworkers, and spouse? Do we avoid holding others to impossible standards? Are we quick to forgive others for misdeeds and apologize when we are wrong?

• Meaning and purpose. Is our life filled with things that truly matter to us and others? People with a high sense of well being actively seek out things that they value, rather than complain about their boredom and unhappiness.

• Accomplishment. Happy people take satisfaction in their many achievements. Regardless of how mundane the task, they feel a real sense of pride in doing something to the best of their ability.

We can learn something from the Girl Scouts in their study of happiness.

I have an amazing sense of relief, gratitude, accomplishment, pride and love as I look over the past year. It’s been an amazing journey that went by in a breeze. Sleepless nights, midnight feedings and unending diaper changes blur my perspective – yet the year was so full, so vibrant and so fulfilling!

I realize – it’s true.  Childhood is joy, laughter, excitement, delight and discovery.  And mommy hood is all of those same things – with a little fear, uncertainty and anxiety mixed in. The ability to live life through a child is the most amazing human experience.

Today I’m celebrating childhood, celebrating mommy hood and celebrating my greatest blessing.

Happy 1^st Birthday Mary Louise – I’m so proud to be your mommy!

I knew it would happen eventually. Thankfully, as far as we know, she has only said it in front of her father and I. (At least daycare has not told me they have heard her say anything.) And yes, I must confess, I am sure that she heard it at home. Jeff and I monitor what we say, monitor the TV, and try to set only good examples. But, we do slip.

This has also been somewhat of a “hot topic” in the media lately due to a recent episode of Modern Family in which the 3-year-old character, Lily, also utters a bad word. On the show, Lily’s dads have to figure out how to handle this situation just like me and my husband have had to with Audrey.

So how do I handle this you may ask?

Last night was the discussion. The explanation that there are okay words when we are upset or something happens and then there are “bad words.” During this discussion though I realized that in my description I sort of glamorized the “bad words, the forbidden language.”

What kid is not going to be tempted to try out those words when there is such mystery surrounding them. They are only words after all. And what defines “bad words?” What is a potty mouth in some families might be acceptable everyday language in other families. How do we remove the excitement of “getting away with something” that drives the experimentation in some children?

For Audrey, at 2 years of age, I feel that a discussion of nice and not nice will suffice at this time. She is very into things that are “nice” – like hugging or sharing, and things that are “not nice” – like hitting, biting or taking toys away from brother. But during this discussion there was a glimmer of testing from Audrey, just a hint of trialing her father and I to see how much she could push us. I do not believe that the discussion of “nice and not nice” will be sufficient motivation to eliminate those behaviors. So I remind myself of other ways to handle the situation.

1.) Prevention is key. Avoid exposing your children to behaviors that you do not want them to imitate. Remember that you are your child’s role model– we are working on this one:)

2.) Explanation of right and wrong and expectations — we have done this.

3.) Remove the shock value. If we do not respond in an escalated manner then it will not be as fun to test us.

4.) Ignore the behavior. This is the technique that we used when she was spitting at us when she did not want to follow our directions or the rules. Her behaviors escalated for a few days and then disappeared and we have rarely heard “pthh” as a response since.

Any discipline techniques you have found helpful in your house with regards to bad language?

Psychologist Lewis Terman began collecting data in 1921 on the lives of 1,500 children to determine what factors were related to longevity. The results have some important implications for the way we raise our children according to Friedman’s recent summary of key findings in the December 2011 journal APA Monitor.

• Stress is not always bad. “….those who worked the hardest lived the longest.  The responsible and successful achievers thrived in every way, especially if they were dedicated to things and people beyond themselves.”
• Conscientiousness was a key personality trait highly correlated with living a long life. Conscientious people tended to live healthier lifestyles, be involved in positive relationships, and have more successful work experiences.
• A strong sense of resolve is critical, since research indicated that “…persistence turns out to be one of the best predictors of health and long life.”
• “…the single strongest social predictor of an early death in adulthood is parental divorce in early childhood,” but that doesn’t mean that divorce is always bad for kids. Divorce represents a serious stress but it can promote resiliency in kids if managed successfully.
• Marriage is not always correlated with a long life, particularly for women. The quality of your marriage was the important factor. Women who separated from unhealthy relationships lived longer than those in unhappy marriages.

How does this research affect the way we raise our children? First, let’s stop trying to protect our kids from stressful events. Many parents make extraordinary efforts to shelter their children. Eighty years of research indicates this is the wrong approach.  Rather, we need to teach our kids how to handle tough situations. This results in an emotional resiliency that will serve them well for the rest of their lives.

Second, traits such as persistence and conscientiousness are highly correlated with living a long life. We should be talking and teaching our kids more about exhibiting good self-control rather than having a positive self-concept. This means saying “no” to something that may feel good today for the benefit of something better tomorrow. When was the last time you complimented your children for having good self-control and not acting impulsively on their feelings?

Finally, the Longevity Project’s data on divorce has provoked much discussion. Divorce does result in kids being at substantial risk, but I suspect less so than growing up in a psychologically unhealthy home. Teaching our kids how to develop and maintain meaningful social relationships is critical. They learn this from watching how we treat our spouse and others rather than listening to what we say.

Are you surprised? No, I the pediatrician do not have any magic tricks to fix this cough either. So let me tell you what happens at our house…

1. Fluids
This is the time when we encourage water, popsicles, soup, anything to get her to drink fluids and stay hydrated. Water is the best mucolytic to help thin the mucous that often triggers the cough. Don’t tell our dentist, but we offer popsicles multiple times a day. It soothes the sore throat as well as hydrates. For a few days I don’t worry too much about solid foods. Fruit is also a great way to stay hydrated.

2. Moist Air
A runny nose and a stuffy nose both benefit from moist air. The moisture helps to keep the mucous thin and makes breathing a little easier. We use nasal saline (even though it is sometimes a battle), a humidifier or vaporizer, and warm baths. I find that the baths are calming and provoke less coughs then her typical play, and they help flush her nose.

3. Rest
Yes, we break the recommendation of two hours per day of TV time. But we also color, read books, paint, and draw. We also encourage more sleep. And it is definitely time to cuddle more.

4. Time
The most important factor. Colds are just a part of life. A typical preschooler will have six to eight colds each year as they come into contact with different viruses. This decreases to four to five for teenagers and fewer with adults – but those of us with younger children will experience more than our counterparts without the little ones. These colds will last up to about 10 days each time. Our children are at greater risk if they are in school or daycare.

5. Hygiene
We wash our hands a lot, and use sanitizer. We use a Kleenex and throw it away. We cough into our sleeves or a tissue and cover our mouth. And we avoid socializing until we are feeling better if we can. One important rule is no school or daycare until we have been free of fever for at least 24 hours without any medicine.

Here are the red flags I watch for to tell me if she may have a secondary infection or that there is something more serious going on and I need to take her to her doctor:

1. Fevers running above 102.5 or lasting for more than five days.

2. Decreased urine output or accidents in those that are potty trained. I use a goal of at least one wet diaper or bathroom trip every four to six hours.

3. Increased breathing rate that lasts even if there is no fever, or increased rate or effort of breathing even when there is no fever.

4. Specific pain complaints like ear pain, or pain with going to the bathroom.

So now I want to know, what are some things you do in your house when your little one has a cough?

Wish Ethan, Daddy and I luck in not catching this cold!

I’ve been buying up a variety of adorable winter pajamas – now in two pieces – so that Mary looks as cute awake as she is asleep. As I was wrapping her gifts this year I noticed a tag on one of her pajama sets. This is what it looked like:

Well – being the Safety Mom that I am, my heart sank a bit. Had I broken a safety rule?

Then I started taking a closer look at some of her other pajamas and noticed that they also had other tags stating that they met flammability standards.

Ironically, within days the Consumer Product Safety Commission had two recalls dealing with products not meeting the flammability standard -one for children’s robes and another for children’s pajamas.

I started a little research to better understand the flammability standards so I can be a good consumer warrior.  I learned from the CPSC’s Children’s Sleepwear Regulations the following:

• To protect children from burns, children’s sleepwear must be flame resistant and self extinguish.
• The rules cover all children’s sleepwear above size 9 months and up to size 14  and require that: (1) the fabric and garments must pass certain flammability tests; or (2) be “tight fitting” as defined by specified dimensions.
• Children’s sleepwear is defined as any article of clothing, such as a nightgown, pajama, robe or loungewear and is intended to be worn primarily for sleeping or activities related to sleeping.

The next time you are in the market for children’s sleepwear hopefully these reminders will come in handy!

After learning this I know I’ll be sleeping better at night – Mary will be sleeping flame resistant!