Resilience: The Anti-Bully

When I was growing up, we had mean kids on the playground, some of whom would meet contemporary definitions of bullies. They were the kids who stole lunch money. They were the kids who offered to play on the teeter totter with the smallest kid in class, only to strand the child at the top, wiggling those twig-like legs and crying. And, the mean girls of junior high are certainly nothing new.

As a pediatrician and mother, I hear people use the term bully a lot. I see kindergarteners so afraid of what goes on in the girls’ bathroom that they withhold pee and start having accidents after years of staying dry. I see kids who run home at full-speed, hoping to get in the door before they are jumped by a crowd of hormone-hyped teens.  I see kids who – after being harassed for months – lurk in the shadows at school plotting their revenge on either themselves or those who’ve hurt them.

Since October is national Bullying Prevention month, I thought this might be a good time to discuss bullying – what it is, what it isn’t, how to teach our children kindness and resilience, and to take a look at a few of the resources out there for youth, parents, and teachers about preventing and reporting bullying.

What is bullying?

We’ve become a society that’s quick to apply labels. My kids have learned about bullies through storybooks and the elementary school experience. They are quick to say they were bullied any time someone is mean to them. I’m not saying that bullying isn’t a serious problem. It certainly is. But bullying is more than just being mean. Bullying involves the intent to willfully and repeatedly cause harm, creating a sense of terror and self-loathing in its victims. It’s like the difference between teasing and taunting. When we tease, it’s lighthearted and innocent. If the person we’re teasing is upset, we stop. Taunting, however, is intentionally humiliating. It tends to become incrementally worse as the victim gets upset.

Apps: Encouraging confidence or revenge?

With Google and the App Store at my fingertips, I took a look at some of the resources available to teach children and caregivers about bullying. What I found at the App Store was alarming: app after app in which the bullied gets revenge. In some, like Playground Bully – No Mercy in the Park, the player becomes the bully by throwing anything from baseballs to grenades and cockroaches around the playground. You can play a wack-a-mole-like game with a bully’s head in Bully Busters Revenge. You can take the Ultimate Slingshot challenge, pelting rocks at athletes, bullies, popular kids, etc. Revenge is the wrong message to be sending kids.

Source: Lee Reynolds (Flickr: CC)

If you’re interested in making the most of your child’s screen-time and think it’s a good way for them to learn, there are a handful of apps out there that teach our kids to identify bullying, and how to ask for help. The Beat THAT Bully app contains a series of videos that teach self-affirming visualizations. Cute cyber-monsters teach kids about cyber-bullying and encourage kindness in Bully Stoppers. Bully 911 is an award-winning app that teaches children the fundamentals of self-defense and addresses the challenges of coping with school bullies. I’m also looking forward to using Kindr, an app that helps you craft and send affirming messages to your friends’ smartphones and tablets. While killing em with kindness might not keep lunch money in your kid’s pocket, it just might teach them to see the good in themselves and others, to name and encourage it. What if the whole world were just a little Kindr every day?

Bully-proofing

We can teach our children to be bully-proof. According to Barbara Coloroso, author of The Bully, the Bullied, and the Bystander, while we can’t eliminate bullies altogether, we can buffer their effects.

Self-esteem is huge here: the better our children feel about themselves, the less likely they are to succumb to bullying. Self-esteem and resilience go hand in hand. Resilient kids are like rubber balls that bounce from surface to surface without losing their shapes. These are the kids who fall down and get back up again, who fail and try again. Their feelings may be hurt by others, but they know who they are, and aren’t afraid to ask for help when they need it.

 

How to Get Your Teen to Sleep in 6 Steps

Teen Sleep Deprivation

Chronic sleep loss in children and adolescents is one of the most common – and easily fixable – public health issues in the U.S. today. Studies show that adolescents who don’t get enough sleep often suffer physical and mental health problems, an increased risk of automobile accidents, and a decline in academic performance.

At the start of puberty, adolescents’ biological sleep cycle shifts as much as two hours later. This makes it difficult for most adolescents to fall asleep before 11 p.m. At the same time, their sleep needs do not decline. The optimal amount of sleep for most teens is in the range of 8.5 to 9.5 hours per night.

The reasons for teens’ lack of sleep are complex. Homework, extracurricular activities, after-school jobs and technology can keep them up late on week nights. Parents, teachers and health professionals should be aware of these factors and educate teens about healthy sleep habits.

 

How to Get Your Teen to Sleep in 6 Steps:

1. Turn off all electronics 60 minutes prior to the time you want them to go to sleep. I used to suggest that parents keep televisions out of kids’ rooms, but this won’t solve your problems anymore. Consider creating a family charging station at which you dock all your devices at a certain time (say 9pm) every evening. There is plenty of evidence indicating that being in front of screens is bad for our sleep.
2. Kids (and adults) should use their beds only for sleep (adults may do more in bed, but this is a pediatric blog).  Encourage your teens to do their homework at a desk rather than in their beds.
3. Change the bathing/showering routine to evening rather than morning. The hot water can them relax.
4. Encourage them to listen to classical music, guided meditations, or white noise to help them power down.
5. Avoid participating in sports practices that keep your kids exercising 2-3 hours before bed time. Sports are fun; exercise is necessary for healthful sleep. But, participating in sports too late in the evening can rev them up all night long.
6. Help them understand their sleep needs. During growth spurts, especially at the beginning of puberty, their need for sleep increases. This means that your adolescents will need more sleep than their younger siblings (read: earlier bedtimes), which often doesn’t sit well.

When you think about it, getting your teen to sleep isn’t that much different than getting any child to sleep. Sure, they are more independent, and too big to sit on your lap. But, they still need you! So much of parenting is modeling healthy behaviors. When it comes to sleep, making sure you get enough, turning down the lights in the evening, turning off the electronics, and allowing your mind to slow a bit from its daily grind are  things you should also be doing – for your health, and to set an example for your kids. We all need bedtime routines!

A sanity-saving bedtime makeover for weary parents

E-Cigarettes: Candy-Flavored Poison

One thing that enrages me about e-cigarettes is that the combination of fruity, candy flavors and television advertising means that kids who might not otherwise be exposed to nicotine or second-hand smoke are curious. In 2009, the FDA banned all flavors except menthol for traditional cigarettes, yet somehow e-cigarettes seem to be designed and marketed specifically to adolescents.

Source: tcavapor. com

E-cigarettes are viewed as less harmful than traditional cigarettes, which release toxins through combustion. But critics say enough isn’t known about e-cigarette health effects and that they serve as a new gateway to nicotine addiction —particularly for youth. The percentage of high-school students who had tried an e-cigarette climbed to 10% in 2012, up from 4.7% in 2011, according to a government study. “The most recent National Youth Tobacco Survey showed e-cigarette use is growing fast, and now this report shows e-cigarette related poisonings are also increasing rapidly,” said Tim McAfee, M.D., M.P.H., Director of CDC’s Office on Smoking and Health. Studies show nicotine negatively affects neurological development among adolescents, including memory and impulse control.

Another thing you won’t see in the ads: liquid nicotine can be lethal.

It can cause harm when it’s inhaled, but it can also be harmful when ingested or absorbed through your skin. One study in the Journal of the American Medical Association finds that liquid nicotine is one of the most lethal poisons. Only a small dose is dangerous — less than one tablespoon of many of the e-liquids on the market is enough to kill an adult, and as little as a teaspoon could kill a child.

Poisoning from conventional cigarettes is generally due to young children eating them. Poisoning related to e-cigarettes involves the liquid containing nicotine used in the devices and can occur in three ways: by ingestion, inhalation, or absorption through the skin or eyes.

According to the CDC, the number of calls to poison control centers regarding e-cigarette nicotine-infused liquids rose sharply, from only one per month in 2010 to 215 per month in February 2014. As many as 51.1 percent of those calls involved accidental poisoning of kids under the age of 5 (roughly 42 percent involved adults age 20 or older).

Dr. Deb Chimes In

As with any other potential dangerous substance, liquid nicotine should never be kept where children might access it. If you do use e-cigarettes, don’t use them around your children. Don’t refill the cigarette in front of your children. Don’t leave the cigarette where a child might find it. Never allow a child to play with an e-cigarette, even if the vessel is empty.

Parents of teens should use the advertising as a conversation-starter with their children and adolescents about the lethal dangers of liquid nicotine, about addiction to nicotine or cigarettes, and making healthy life choices.

New study shows SOME video game time can be good for your kids

Risky Youth Behaviors: Sex, drugs, and tanning beds

Results of the CDC’s annual Youth Risk Behavior Survey (YRBS) are in for 2013. As a pediatrician, I find myself wondering what we’re doing about parent education – does it stop once a child starts school? It shouldn’t! Sometimes it feels like parenting changes daily. We never know what our children will come across on a given day and bring up over dinner. We still need help – from pediatricians, from family and friends, from teachers – to understand where our children are developmentally and how we can teach them to care for themselves.

As a parent, reviewing these results is a eye-opening experience. Nationally, about 5.6% of teens indicate they started having sex before age 13. My daughter’s nearly 10. Even if she’s not among the 5.6% of sexually active youth at her age, she might go to school with someone who is. It’s time we started discussing physical intimacy and the potential risks of this early sexual activity. The survey results also indicate that, of youth that are sexually active, 40.9% didn’t use a condom the last time they had intercourse. In my home state of Ohio (deep breaths mom), 49.2% say they didn’t use a condom.

Risky behaviors aren’t just unhealthy, they can have long-lasting impacts on other areas of a kids’ life. Take a look at the average grades of youth who engage in these risky behaviors:

Source: http://www.cdc.gov/healthyyouth/health_and_academics/pdf/health-academic-achievement.pdf

Other concerning risks behaviors that are both parenting and public health concerns include:

• Though 1 in 5 people in the United States will develop skin cancer in their lifetime, 89.9% of youth surveyed indicated that they only sometimes, rarely, or never used sunscreen. Anecdotally, when I ask patients about it, it’s even more concerning to me that kids are least likely to use sunscreen when they put themselves in the microwave oven scenario of being in a tanning booth. Please don’t let your kids lay on the surface of the sun, even with protection.
• We can’t expect our children to learn and grow when they are overtired. According to the YRBS, 68.3% of youth reported not getting 8 hours of sleep on average school nights. Social media and handheld devices are a nasty combination when it comes to sleep hygiene. Kids report feeling as though they “don’t want to miss out on something” and are busy tweeting and snapchating in bed into the early morning hours. Consider a family docking station where everyone (yes, even you) charges portable devices overnight. Computers and TVs never need to be in a bedroom, but if your kids have any electronics they need to be turned off at bedtime.
• Looking at population trends over time, the percentage of youth that don’t attend school because they felt unsafe at school, or on the way to or from school, has climbed slowly, from 4.4% in 1993 to 7.1% in 2013. I wish I had an easy answer for this. Youth violence is an incredibly terrifying public health concern, leaving most of us (youth, parents, teachers, physicians) feeling helpless. Perhaps one of the most important things we can do for our kids is to keep the lines of communication open. If your kids push you away (as they will often do throughout their adolescence), trusted adult friends (family friends, aunts and uncles, grandparents, teachers, etc.) may have more success.

 

We’ve found over time that if parents bring up topics with their kids it’s amazing what they’ll share with you. So put away your discomfort around sex, drugs, bullying, smoking, electronics, social media – whatever it is – and talk to your kids!

There seems to be a significant lack of parenting guidance as our children age. Expectant parents take classes to learn the basics of baby care. When children are born, parents receive unsolicited advice every time they leave the house (not to mention on social media). Within the first 18 months of life, many parents bring lists of questions to their infant’s medical check-ups. These routine check-ups give pediatricians the opportunity to remind parents about age-related safety concerns. Yet, once your child begins kindergarten, check-ups become less frequent and more complex. Kids feel uncomfortable when you talk about them in front of other adults  – but that’s primarily around things like being overweight so don’t feel like you have to have conversations about tough topics without your kids – knowing you’re concerned might help them to understand the significance of the issue. If you do have sensitive questions, ask to speak with your child’s pediatrician in private – or call the office a couple days before the visit and leave a message so your pediatrician can already be “in the know” at the visit.

Life is a process of learning and growing. When you become a parent it means you learn and grow for 2… Keep the lines of communication open. Don’t assume that because you live a particular lifestyle (socioeconomic, religious, etc.) that your kids are safe. Talk about important things even if they make you uncomfortable. Let’s make the next generation safer and smarter!

 

Play Time: Five Steps to Engaging with a Special Needs Child

All children have the ability play, in one form or another, but adapting to a child with special needs can seem more like work for caregivers. The word disability carries a heavy connotation and there is a lot of work involved – but they’re still kids, so don’t ignore play!

 

Play is so important that, according to the American Academy of Pediatrics, it has been recognized by the United Nations High Commission for Human Rights as the right of every child. Play contributes to nearly all aspects of a child’s well-being, and also offers their parents and caregivers opportunities for engagement. Play makes all of us healthier and live longer – it does great things for our psyches regardless of age or ability!

CC: SteveEF

 

While websites like Beyond Play and Ability Path are both excellent resources for tailoring playtime to your child’s abilities and disabilities, here are five things it is important to keep in mind when playing with any child:

 

1. A special need is a variable in play, not necessarily a hindrance. Keep the child’s abilities, as well as disabilities, in mind when designing the activities and environment they will have available to them. Be sure to factor in physical, intellectual, emotional, and mental issues that could arise. This is especially important when dealing with children on the autism spectrum. Unsure of where to start? The Child Mind Institute has a wide variety of facts (and even debunks some myths) about common special needs and mental illnesses.
2. Try to make toys as multisensory as possible. This just means that the toy would use two or more senses. Toys that light up, make noise, or have a variety of textures, are all good examples. Play sets that involve lots of pieces, such as one that can be used to build a specific setting, may do well. When engaging in imaginary play, good old-fashioned Legos might just be your best bet. For a more complete list, go to the delightfully titled Fat Brain Toys.
3. Let the child lead. While it is always good to be a role model for a child, allowing them to initiate playtime is a great step towards them being able to play with others. All kids want to feel in charge and they want to get their parents’ encouragement – so engage them in things that interest them but let them lead, don’t over-structure the activity.
4. Be energetic. If you’re having fun they will want to play more too!
5. Ask questions. Verbal and nonverbal children can keep growing their brains through puzzling out questions. Even if you already know the answer, asking questions can help the child’s interactive and verbal skills; it also positively reinforces them when they’re right and helps them make a positive connection with you.

 

 

When a Semi-Automatic Response Won’t Do

Today’s headlines are full of news about the most recent school shooting. As a parent, this is terrifying. As a pediatrician, it’s both incredibly sad and frustrating. I’ve dedicated my life to keeping kids healthy. It’s always hard when children die: when entire communities grieve the loss of that child’s spark and potential. Sometimes it’s disease that is responsible – but much more often it is preventable accidents.

Schools should be safe places. Yet, there’ve been 74 school shootings since the horrors at Sandy Hook. As a nation, we’re averaging over a shooting per school week. During the evacuation of Reynolds High School in Troutdale, Ore., authorities found another student with a gun in the school. This gun wasn’t related to the shooting. But, one has to ask: why in the world are students bringing guns to school? And how do they get them?

In a country with our enormous resources we should all be shocked that homicide remains the second leading cause of death for all children aged 1-19, according to the American Academy of Pediatrics. Black teens are in an even more precarious place – with homicide being the leading cause of death for black kids aged 15-24.

I have no interest in politics when it comes to the safety of children, only common sense and responsibility. I have no desire to hunt, nor do I care to take away everyone’s reasonable weapons. But no one needs a massive magazine. I wish I could live in a world where the only magazine my kids had to learn about had pictures of Beyonce and Justin Bieber.  But I don’t and I have to be a realist in addition to a dreamer.

So, I have a dream.

In my dream, children are safe in their schools. Kids aren’t exposed to guns there.  There are mental health resources available to those who need them – and they are easily utilized. Every child has a pediatrician, and scheduled check-ups so that mental health issues can be detected early and treated and so that we pediatricians can help level the playing field for parental education. All kids have the same opportunities – for education, for extracurricular activities, and, yes – for food and shelter.

And I understand reality – so in our home we sometimes ask our kids (girl, 9 and boy, 6) about guns. We recently asked them again: “what would you do if you found a gun?” Our son doesn’t understand the difference fully (nor is he expected to) between play guns and serious weaponry so I worry that he would play with it… But he’d give it to his teacher (I think he has a crush on her). So that’s guns 1, parents 0 because he needs to leave it on the ground so he doesn’t blow away his class by accident… Our daughter would not touch it and would tell a grown up. She learned from our panic attack at last request when she would have thrown it away…so as highly educated and passionate individuals we’re only batting .500.

Please keep your reasonable guns locked and empty. Please talk to your kids. Please teach responsibility. And please help to create a world where we can still raise dreamers.

Smart Baby Tech Makes for Helicopter Parents

Parents: The original baby monitors

Saturday morning my spouse and I had a kid-free (!) picnic breakfast at a lake near our house. We sat about 10 feet away from a pair of geese with their new goslings, just watching. For a while, the adult geese kept a close eye on us – but when we didn’t make any sounds or sudden movements, they went about their business of pecking at their food in the grass.

I’m always fascinated by watching how other species interact with their young. These geese had Spidey sense for sure. They heard sounds long before we did, be it the red-winged blackbird leaving its nest, a hawk flying overhead, or just a guy walking his dog. With one small grunt, they alerted their babies of impending danger and every one of them scuttled to safety in a straight line.

As a mom, I often feel like those geese, exhausting all my senses trying to steer my kids away from all potential dangers. When they were babies, my spouse (who was particularly nervous about SIDS having lost a brother at three months) ordered what was then (a decade ago) much more rare – a baby monitor that senses movements in the crib (aka breathing) and alerts parents when more than 30 seconds go by without a movement.

Did this monitor stop me from opening the nursery door to listen to my sleeping infant? Not a chance. It also gave us a few terrifying nights when the baby had rolled to the edge of the crib and, though she was still breathing, the monitor couldn’t pick up the movements.

New smart baby technologies may breed more anxiety

Recently, I was at a conference about data and healthcare. All the techies and younger parents were excited to hear about the latest baby monitors that alert parents to babies’ needs (i.e., the baby is awake, has rolled over, or requires a diaper change) and also track data like heart rate, oxygen levels, the number of wet diapers, feedings per day, etc. There are even diapers that tell you if your baby has a urinary tract infection. If you’re lucky enough to speak Portuguese, your baby’s diaper will Tweet you when it’s wet.

So, 21st century parents can use their smart phones and wifi connections to monitor and track their babies’ inputs and outputs. Is all this information helpful? Just because we can track this data – should we? Does having more information really relieve our anxieties? Or does it reinforce our worries, stripping away our sense of parenting efficacy?

If your child has special needs, discuss your concerns with her pediatrician and ask about what technologies might be helpful. If you’re the type of mom who checks on her sleeping children multiple times before turning in for the night, chances are, you’ll be even more glued to your smartphone, but instead of waiting for a message from a friend or checking Facebook, you’ll be waiting for your baby to take her next breath. And the one after that. All this smart baby technology can increase parental anxiety, which can actually have a negative effect on kids.

No amount of technology can protect our kids from life. Nor can parenting. Life happens. We can prepare our kids for it: by teaching them to trust us by caring for their needs, by reading to them (don’t even get me started on pajamas that read to your kids). We can try to keep them safe by putting them to sleep on their backs, removing blankets and stuffed animals from cribs, baby “proofing” when they get mobile, and teaching them to be street-wise. But, if we monitor them like crazy, we’re not doing anyone any favors.

Take the money you’d spend on these smart baby technologies and start a college fund. Some day, your baby will be smart all by herself – no sensors attached.

 

6 Bike Safety Lessons to Get You Ready to Roll

Courtesy of Flickr (CC)

As parents, we are all concerned about keeping our kids safe: safe from strangers, safe from cuts and bruises, safe from the monsters they think hide under their beds. While we should be careful not to overwhelm our little ones with our anxieties, it is important to teach our children about playing safely outside.

When it comes to bike riding, safety is especially important. Did you know that only about 45% of children under the age of 14 wear a helmet while riding? Dr. Deb Lonzer recommends putting a helmet on your children the first time they climb on a tricycle. It’ll become second nature and will save you a lot of hassle down the road. It’s a simple rule really: no helmet, no wheels.