Parenting can be hard. Everyday stresses can decrease patience and make parenting even harder. Always try to slow down, take advantage of every moment, and seize the opportunity to turn negative experiences into positive ones.

Consider the following ways (as recommended by the American Academy of Pediatrics) to show your child your love this Valentine’s Day and every day.

1. Use Words with Care
Choose positive and encouraging words, and those that model consideration and gratitude, to help build your child’s building self-esteem. The opposite can occur when negative words or sarcasm (which is typically not understood by children) are used.

2. Spend Time Together
Hold the time together (even if limited) with importance. Celebrate the quality of the time, not the quantity. Try to take time for one-on-one activities with each child. Ensure the time is uninterrupted by cell phones or other devices. Switch off the electronics and play board games or enjoy an outdoor activity.

3. Have Heart-to-Heart Conversations
Make sure you take the time to listen to your child’s response to common questions like “How was your day?” Ask about challenges they may be experiencing and let them finish the story before you offer a solution. If you worry your child is anxious or depressed, make sure to discuss your concerns with your pediatrician

4. Give Hugs First
Human contact has shown to be a calming measure for anger and other situations in which the child may be in a bad mood or grouching. A quick hug, cuddle, pat on the back or nod or some other sign of affection can be used before talking through the difficulty. Consider waiting to discuss it further until after some time has passed when they are feeling better.

5. Always Listen
Ensure your child knows you are always listening and ready to respond promptly and lovingly. Being available to listen when your child wants to talk, even if it’s not a good time for you. This shows your child that they are a priority and tends to help with reciprocating when it's their to listen.

6. Discipline with Love
Use positive, non-violent discipline instead of physical and verbal punishments, which can negatively impact the physical and mental health of children. Clear and consistent rules are important from an early age. When rules are followed, offer praise. When they’re not followed, calmly describe consequences and follow through with them.

7. Forgive Mistakes
If you respond too harshly, make sure to apologize and explain how you will change your response in the future. No one is perfect, so forgive yourself when you react harshly. Teaching forgiveness will also teach a child to accept their own mistakes and build their confidence.

8. Create a Love for Reading
Start reading to your child during infancy. Many studies show children who are read to early and consistently have increased school success. Some studies also show that a parent-child bond is strengthened by spending time reading together.

9. Cook and Eat Together
A good way to enjoy each other's company is to spend quality time cooking and eating together. This also gives parents an opportunity to teach kids about good food choices.

10. Foster friendship
Help your child build positive relationships with friends, siblings and other family and community members. Consider helping your child volunteer or participate in other opportunities in which you can help those in need together. Encourage them to play sports or other activities that require teamwork. Spend time with neighbors doing fun activities. This can be especially hard during the pandemic, but technology can help keep people connected.

11. Adopt a Pet
Consider bringing a pet into your family. Animals can increase physical activity, enhance overall positive feelings and also give children an opportunity to connect with someone they care about. This can also offer an opportunity to develop the sense of responsibility when age-appropriate.

12. Model Health and Safety
Keep your child healthy by taking them to their wellness checks at age-appropriate intervals. Model a safe and healthy lifestyle, including nutritious eating, adequate sleep and exercise.

13. Give Affection and Attention
Make time every day to talk. Children and adolescents are more likely to make healthy choices if they are well connected with family members.

14. Use Words of Affirmation
Don’t forget to say “I love YOU!” as much as possible.

Valentine Heart Attack

Here is a great idea for Valentine’s Day (and you have plenty of time to get some of these heart messages on display for your child before Feb. 14). Give your child a ‘Valentine Heart Attack’ by cutting out paper hearts and writing nice, positive comments about them. Then, use the hearts to decorate their bedroom door. You can write one or two a day for a week leading up to the holiday, or if you are in a time crunch, write them all the night before and decorate the door with all of them.

Download free heart templates here.

Happy Valentine’s Day!

The past nine months have been marked by upheaval, uncertainty, isolation and change with the youngest among us feeling the weight of it all, and doctors at Cook Children’s Medical Center are sounding the alarm.

“I’ve been employed as a psychologist at Cook Children’s going on 26 plus years and never in my time have I seen such an intense number of patients with severe anxiety and depression,” said Lisa Elliott, PhD, manager of the behavioral health clinic at Cook Children’s. “It’s not uncommon for us to have high acuity patients periodically, but that’s become the norm for weeks and weeks where 70 to 80 percent of our total number of visits for anxiety and depression are severe.”

Dr. Elliott attributes the uptick, in large part, to fallout from COVID-19. 

A June 2020 survey of parents published in the medical journal “Pediatrics” revealed that, since the start of the pandemic, more than 1 in 4 parents reported a decline in their own mental health, and 1 in 7 reported worsening behavioral health in their children. Both a decline in parental mental health and child behavioral health were reported by 1 in 10 families, according to the study “Well-being of Parents and Children During the COVID-19 Pandemic: A National Survey.”

Cook Children’s mental health experts say screen time, social media, academic performance pressures and lack of sleep all stress a child’s mental and behavioral health. All of those stressors have been exacerbated this year by pandemic-induced factors such as school closings, virtual learning, social distancing and isolation, according to Kathleen Powderly, M.D., a pediatrician on the medical staff at Cook Children’s. If ignored, these pressures can be a breeding ground for anxiety and depression.

And mental health experts are bracing for what is yet to come during the holidays as it’s not uncommon to see an uptick in depression and anxiety in children this time of year, particularly when there has been a significant family change, like in the case of divorce or loss of a loved one, according to Dr. Elliott.

So what is a parent to do? How do we help our children process these pressures to protect their mental and emotional well-being?

“We have to instill hope and stay calm and reasonable about it and, at the same time, not show fear.” Dr. Elliott said. “This is critical because we are going to set the tempo for our children. We will be what they follow. So it’s critical that we are calm and follow the safety guidelines, but tell our children this is not the way it’s going to be forever.”

And what better time than the holidays to model, teach and inspire hope?

Generosity Breeds Health and Hope

As stressful as the holiday season in tandem with a pandemic can be, it also presents a unique opportunity to teach children a concept that studies show actually improves mental health. It’s long been known that generosity and giving incite the same increase in one’s happy hormones as exercising. Giving makes you feel good—emotionally and mentally.

“Research shows that in addition to eating healthy and getting quality sleep, there are three things we can do to help keep depression at bay,” Dr. Elliott said. “One of them is exercising and another is socializing because they both increase endorphins. But the one that has the most long-lasting impact is philanthropy work. Doing things for others.”

A 2018 study published in the journal “Psychosomatic Medicine: Journal of Biobehavioral Medicine” showed a correlation between giving and increased activity in parts of the brain associated with altruism, reward and parental care and behavior. It further demonstrated that acts of generosity toward a targeted, or known, individual in need resulted in reduced activity in the amygdala—a positive given the amygdala is an emotion processing brain structure that signals the fight-or-flight mode when under stress. Increased activity in the amygdala is often seen in individuals with anxiety.

In addition to the chemical reactions philanthropy produces in the brain, doing good for others can help reframe one’s focus. Seeing the pain, suffering and circumstances of others gives perspective on one’s own struggles.

“Volunteer work helps create compassion because it draws concern away from ourselves,” Dr. Elliott said. “That’s why doing for others is so valuable for children. It teaches them compassion and optimism, and helps them develop gratitude.”

It also promotes the concepts of empathy and resilience, which are important building blocks for emotional and mental strength and valuable coping skills that help children deal with other challenges that come their way, according to Dr. Elliott.

This year, the need for generosity and service to others is especially great, given the economic impact of the pandemic. COVID-19 safety guidelines may require outside-of-the-box thinking to safely, yet personally, meet a need, but don’t let that stop you. It’s a great opportunity to get creative with your child.

With the help of Cook Children’s certified child life specialist Lauren Lasrich, MS, CCLS, we’ve compiled a list of ideas to help you and your family get started.

• Pack a grocery bag full of items and ingredients needed for Thanksgiving dinner for a neighbor in need. Let your child help create the menu and shop for the items together, either online or in the store. Deliver the groceries to their doorstep with a homemade card created by your family/child.
• Gather the family to rake leaves and clean up the lawn of an elderly or disabled individual. You’ll help a friend and get some sunshine and exercise for yourself and your family at the same time. Sunshine and physical activity are mood boosters!
• Adopt a family in need for the holidays. Check with your child’s school to see if they collect Christmas gifts for students in need and offer to purchase something on the student’s/family’s wish list. Get your child involved in the shopping process, be it online or in store.
• Together with your child, research a local organization or charity that promotes a cause you connect with and find out how you can help them meet the needs of those they serve. Create a family donation jar and save change to donate to the charity.
• Organize a neighborhood food drive and collect non-perishable food items from your neighborhood to donate to a local food pantry. Let your child decorate a donation box and put it on your porch so that your neighbors can safely deliver their donations.
• The end of the year is a great time to reduce and reuse! Go through your house and collect gently used household and clothing items you no longer need/use to donate to a local charity.
• Write letters/draw pictures to deployed military members or health care workers. For information on how to do this, or other ideas for supporting our troops, check out How Can I Support the Troops? 5 Ways You Can Help Deployed Soldiers at uso.org.
• Do a drive-thru Christmas caroling tour in your neighborhood. Let your neighbors know ahead of time when you plan to be out caroling so they can step outside and enjoy the show. Decorate your car ahead of time as a festive and fun family activity.
• Make toiletry kits and donate them to a local homeless shelter.

Not only will these activities help others, but they’ll give your child a project to look forward to.

“I tell people, especially during the pandemic, you have to have one thing to look forward to,” Dr. Powderly said. “It may not be the same thing that you enjoy previously, but you have to have something to look forward to because it gives you hope, and that’s what we all kind of need a little bit more of right now is hope.”

What to Watch For

Knowing the signs and symptoms of anxiety and depression can help you help your child before things get severe. For children, look for three or more of these symptoms, according to Dr. Elliott:

• Excessive worry for more time than typical. The difference between normal worry and anxiety disorder is the severity.
• Difficulty controlling worry.
• Easily fatigued.
• Restlessness and difficulty concentrating.
• Irritability.
• Muscle tension.
• Sleep disturbances.
• Sudden change in grades and school performance.
• Disinterest in a previously loved activity.

If your child is experiencing any of these symptoms and you are concerned about their mental or behavioral health, Cook Children’s is here to help. To access any of the hospital’s behavioral health services, call 682-885-3917. For emergencies, call 911.

How long should I breastfeed?

It seems like a simple question, but not one I feel I can answer with an exact time frame.

The World Health Organization and UNICEF recommend breastfeeding for two years, while the American Academy of Pediatrics (AAP) suggest “one year or longer.” Though these seem slightly varied, all agree that exclusive breastfeeding is best practiced until 6 months when solids are added. None offer an upper limit to the duration stated.

A recent study in Pediatrics states, “increased duration of breastfeeding… protects against infections requiring hospitalization in the first year of life but not hospitalizations or symptoms of infection at home beyond the first year.”

But this duration of breastfeeding may not be possible or sustainable for some families.

So how long do I recommend?

Short answer: For as long as you can... until you no longer feel served, available, able, or mutually fulfilled. Until you’re done.

Breastfeeding is certainly a labor. It doesn’t come easy to everyone. Some actually hate it and look forward to the day they can close the chapter and move on.

For those moms, the time may be now, because in the U.S., we do have alternative-milk options that do a great job in growing our kids.

But it is important to understand that breastfeeding doesn’t have to be all or nothing. Any is better than none. A week is better than a day. And there are benefits to two years that will exceed the benefits of a year.

So on the other end, when should we call it quits?

The answer for me is the same: For as long as you can... until you no longer feel served, available, able, or mutually fulfilled. Until you’re done.

And if it feels like you have to stand up for your feeding journey, because you buck the cultural norm here in America, the AAP has your back:

“Data on the scientific foundation for an age above which is appropriate or harmful to the child to continue breastfeeding do not exist. Nor are there reported risks to this method of social/nutritional interactions.”

Breastfeeding a toddler isn’t weird.

As always, I stand firm in my word.

If the baby is growing, if the momma is happy, and if the baby is happy then we are doing things right-breastfeeding, formula feeding, some of both.

Please reach out to me for coaching, encouragement, and ongoing support, so I can help you to meet whatever goal you have made to feed your child.

“What’s school going to look like in the fall?” “Should I send my child or keep them at home?”

These are the questions that every parent is probably already asking as school districts roll out their plans for re-opening school in the context of continued COVID-19 cases in our communities. Many schools may present the option for all in person, all online or some blended method. And parents will have to consider what works best for their children.

There have been many stressful decisions in regards to COVID, but this might be the most anxiety inducing one for parents so far. School districts realize how stressful this is for parents and are taking steps to protect their students and your kids.

 “We understand that some of our families are anxious about the new school year so we are implementing strict new cleaning protocols for every campus. That means that schools will be cleaned multiple times during the daytime hours rather than in the evening as has been the practice for many years,” said FWISD Superintendent Kent P. Scribner. “We are also making a significant investment in both Personal Protective Equipment--for both adults and children—as well as cleaning supplies for campuses and other FWISD facilities. The good health and safety of our students and employees remains our top priority.”

The Texas Education Agency released these guidelines for school reopening on July 7, 2020:

• Daily on campus learning will be available to all parents who choose that option for their children
• Parents may be asked to commit to remote instruction for a full grading period but will not have to commit until 2 weeks ahead
• Health and safety procedures should be in place for student and teacher safety

In normal times, making a decision about what your child will do for school in the middle of July would seem way too late, but this year it feels way too early.

Each parent will have to make their own decision but here are some things that it would help to consider:

Childcare and Other Resources

First and foremost, it’s important to consider that children attending school is an important part of allowing parents to work and function in society. Parent’s jobs help secure food, shelter and in many cases provide health care insurance that allow children to receive care when needed. Not all parents can work from home, stay productive and keep a job. In addition, many of our children receive their most nutritious and guaranteed meal during the school year through their school lunch. Schools provide many resources to our communities and children beyond education.

Medical

Healthy children, for the most part, are considered to be safe in the school environment. Children have been more or less spared from severe illness but, as with most illnesses, children with chronic medical conditions are at higher risk for severe illness. Parents of children with medical conditions may learn toward keeping their child in the online environment in order to protect them from exposure. In addition to the child, considerations must be made for other household members and extended family members with whom the child might have contact. If the child will have contact with family members who have weakened immune systems, they could bring the virus home despite not having significant symptoms.

School

Examining the policies and procedures of the school will be another important decision point for families. Is the school district taking the recommendations for safety seriously and attempting to implement them consistently? With kids involved, there will be a learning curve but districts should be considering policies in regards to social distancing, mask use and movement throughout schools at a minimum. The evidence suggests that most schools are taking the threat of COVID very seriously but each parent should make that assessment for themselves.

Educational

April and May taught us a lot about how capable our students were of learning in an online environment. While the school districts will be significantly more prepared for teaching online, there are certain kids for whom it was obvious that the online environment was not going to be the right choice for them. Children who receive services and support at school might have a more difficult time adjusting to life at home without that extra help. For others, they struggle to learn online and in-person teaching might be a better fit. In addition to the child’s learning needs, families must consider their ability to support their learner with their existing responsibilities. Teachers and school staff can help, but students at home will often require some, if not significant, guidance from someone in the home. This is especially true for younger students and those with special learning needs.

Social and Emotional Needs

Some kids have thrived in regards to their mental health with the online learning environment. Many children with anxiety in regards to school or formalized testing had significant improvement in their symptoms as they transitioned to at-home learning. Other students and families needed the structure and activity of school in order to maintain a sense of normalcy. The lack of contact with friends, teachers and other school staff affected them in very negative ways. Another consideration should be the child’s level of concern about COVID-19. Children with significant anxiety regarding the virus could anxiety, depression and other severe health and mental health issues.

Decisions regarding going back to school in the fall are complex. Each parent should consider how the effects of being at school or at home would affect their children and consider that as part of their decision.

For more information on this topic, read the recommendations of more than 50 Cook Children’s pediatricians, led by Medical Director of Infection Prevention, who worked to create guidelines for returning back to school. The AAP released similar guidelines that support opening of schools for in person instruction.

It’s likely the plans for each school will continue to change throughout the rest of the summer. Parents should consider the best option for their children and be prepared for disruptions to occur based on local case numbers.

For more on this topic:

• Cook Children's Physicians Create Guide to Help Kids Safely Return to School amid COVID-19 pandemic
• COVID-19 Planning Considerations: Guidance for School Re-entry (AAP)
• Young Athletes and COVID-19: 'When Can My Child Start Playing Sports Again?'
• TEA Issues Comprehensive Guidelines for a Safe Return to On-Campus Instruction for the 2020-21 School Year

Those recommendations are based on the latest research from the American Academy of Pediatrics. The organization, which represents about 67,000 pediatricians from across the nation, will release its findings in the AAP’s own journal Pediatrics in the December issue.

The AAP’s revised policy cites new evidence linking “corporal punishment” to an increased risk of negative behavioral, cognitive, psychosocial and emotional outcomes for children. In the updated policy, the AAP defines corporal punishment as the “non-injurious, open handed hitting with the intention of modifying child behavior.” Defined this way, corporal punishment is distinct from child abuse.

The new guidelines from the AAP takes a much stronger stance on corporal punishment, as opposed to the previous “guidance on discipline” published in 1998 that recommended parents be “encouraged” not to spank.

“I hope this study helps parents look at why they discipline. The purpose for discipline should be to change a behavior for the long term, not punishment,” said Jamye Coffman, M.D., a child abuse pediatrician and medical director of the C.A.R.E team at Cook Children’s.

Along with spanking, the policy also addressed the harm associated with verbal punishment, such as shaming and humiliation.

“Research has shown that striking children, yelling at them or shaming can elevate stress hormones and lead to changes in the brain’s architecture,” a statement released from the AAP said. “Harsh verbal abuse also is linked to mental health problems in preteens and adolescents.”

Instead, the AAP encourages the reinforcement of appropriate behaviors, set limits, redirect children and set expectation.

“Punishment that shames or degrades a child is never OK,” Dr. Coffman said. “It can lead to anxiety, depression, and aggression in the future. It can also harm the parent/child relationship leading to a cycle of behavior problems.”

The study was conducted in the 20 largest U.S. cities. The research found that children who were spanked more than twice a month were more aggressive in the surveys that followed.

“Children who experience repeated use of corporal punishment tend to develop more aggressive behaviors, increased aggression in school, and an increased risk of mental health disorders and cognitive problems,” the AAP stated. “In cases where warm parenting practices occurred alongside corporal punishment, the link between harsh discipline and adolescent conduct disorder and depression remained.”

The research found it was not unusual for parents to spank their kids occasionally, certain factors increased the use of corporal punishment, including parents who suffer from depression and families facing economic challenges, mental health problems, intimate partner violence and substance abuse.

More information from the AAP

• Effective Discipline to Raise Healthy Children (the study)
• Disciplining Your Child 
• Time-Outs 101 
• Discipline vs. punishment: What works best for children? 
• How to Shape and Manage Your Young Child’s Behavior 
• Components of Good Communication
• Disciplining Older Children
• Where We Stand: Spanking

The policy statement from the AAP “provides 5 evidence-based recommendations for best practices to optimize safety in passenger vehicles for all children, from birth through adolescence.”

The policy statement from the AAP gives these five recommendations:

1. All infants and toddlers should ride in a rear-facing car safety seat (CSS) as long as possible, until they reach the highest weight or height allowed by their CSS’s manufacturer. Most convertible seats have limits that will permit children to ride rear-facing for 2 years or more.
2. All children who have outgrown the rear-facing weight or height limit for their CSS should use a forward-facing CSS with a harness for as long as possible, up to the highest weight or height allowed by their CSS’s manufacturer.
3. All children whose weight or height is above the forward-facing limit for their CSS should use a belt-positioning booster seat until the vehicle lap and shoulder seat belt fits properly, typically when they have reached 4 feet, 9 inches in height and are between 8 and 12 years of age.
4. When children are old enough and large enough to use the vehicle seat belt alone, they should always use lap and shoulder seat belts for optimal protection.
5. All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

Resources For Parents

• Child Passenger Safety Guidelines from AAP
• Vehicle/Car Safety
• The Ultimate Car Seat Guide
• Road Rules for Little Passengers
• Child Passenger Safety Considerations For Organizations Transporting Children

Mercury (Thimerosal)

Thimerosal is a preservative that was used in vaccines starting from the 1940s. The preservative contains a small amount of mercury and chronic mercury toxicity has been shown to be related to psychiatric problems and other medical issues. Because of this, it was brought up as a concern around 1999 because the overall number of vaccinations was increasing that perhaps over time the exposure to mercury could be a cause of autism.

Studies started quickly to determine if this could be the case, but in the meantime, the vaccine companies, at the request of the American Academy of Pediatrics (AAP) and the Food and Drug Administration (FDA), began to take Thimerosal out of their vaccines. Thus, by 2001, Thimerosal (and mercury) were removed from vaccines except for one exception (see below). Fortunately, in 2004, further studies released by Institute of Medicine determined that mercury was not a cause of autism.

Currently, the only vaccines that contain mercury that I offer in my clinic are seasonal flu vaccines when they are given in a mutli-dose vial. I try to order as much “preservative free” flu vaccine as I can so that this is not even a concern for my patients. However, because studies have shown that mercury is not a cause of concern, I do not worry that receiving their flu vaccine from a multi-dose vial would harm my patients.

MMR Vaccine

Autism is generally diagnosed around 15-18 months, right after the time when children receive their measles, mumps and rubella (MMR) vaccinations. I believe that is because of this relationship in time that MMR was ever thought to be associated with autism.

The original paper that reportedly found a relationship between MMR and autism by Andrew Wakefield was published in The Lancet. The research has now been completely discredited after multiple other scientists were unable reproduce the results and significant problems with the methods he used for conducting his research. In addition, further information has come out regarding Dr. Wakefield’s conflicts of interest and his motivation for publishing the paper. Over time, ten of the twelve authors involved in the writing of the paper retracted their support of its conclusion.

Finally, after many years, The Lancet published the following statement, “We wish to make it clear that in this paper no causal link was established between (the) vaccine and autism, as the data were insufficient. However the possibility of such a link was raised and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper.”

Despite this overwhelming criticism of his paper, the damage done by Dr. Wakefield and The Lancet still persists today. Parents continue to ask about and remain fearful of MMR and a possible (although incorrect) link to autism. His belief caused parents to fear the use of MMR vaccine and unfortunately, this often extends to all vaccinations.

“Too Much, Too Soon”

Are children getting too many shots too soon?

Will receiving all the scheduled shots, so many more than we got as kids, overload their immune systems?

This is a conversation I often have with parents of newborns. And despite the fact that I’m pro-vaccine, I am not afraid to have discussions with parents who have fears and simply want what is best for their child.

Because of that, I follow the evidence closely and love to see new studies that look at different angles of the vaccine discussion.

That’s why I was I excited to see a recent study in the Journal of the American Medical Association (JAMA) that analyzed children with infections not covered by vaccines to determine how many vaccines they had received and if that was a potential reason why they got the infection.

The research looked at around 200 children with diseases and compared them to 750 other children. Those who contracted the diseases had a total vaccine exposure of 240.6 antigens while those in the control (without the disease) group had 242.9.

So, it doesn’t appear that vaccine load on the immune system is a contributing factors towards children contracting other diseases.

This study is another perspective and further evidence that lends support to the idea that vaccines are one of the most successful, safest advancements in the history of medicine.

The 28 year old also suffers from depression.

"It's one of them things that no matter how indestructible we look like we are, we're all human at the end of the day," DeRozan said in an interview with The Toronto Star. "We all got feelings ... all of that. Sometimes ... it gets the best of you, where times everything in the whole world's on top of you."

DeRozan is not alone. Research shows that 1 in 5 teens experience depression at some point during adolescence. Unfortunately, studies also show that many parents miss the signs of three kids with depression go undiagnosed.

Because of these numbers, the American Academy of Pediatrics has updated their guidelines to recommend pediatricians routinely check for signs of depression in their young patients. The focus is to carefully screen patients ages 12 and over during annual checkups.

Kathleen Powderly, M.D., a Cook Children’s pediatrician in Fort Worth’s Magnolia office and a hospitalist, is very involved with this topic. She will be a keynote speaker at a community educational seminar on suicide prevention called the No More Symposium from 6:30 p.m. to 8 p.m. at Bluu Auditorium on the TCU campus. Dr. Powderly will discuss anxiety, social media and bullying.

Dr. Powderly is encouraged by the updated guidelines by the AAP and says 12 years old is the right age to begin checking for depression on a regular basis.

“The data I’ve been tracking as a hospitalist shows the average age of kids admitted to the hospital for suicide attempts is 14.4 so that is a good age,” Dr. Powdery said. “On average, the hospitalist service (at Cook Children’s) has admitted a child with a suicide attempt every 2 days for the last 3 years. The Symposium focuses on the multifactorial nature of anxiety, stress, suicide and how they relate. More importantly, it gives parents and the community at large tools and ideas to handle this growing problem.”

Vanessa Charette, M.D., shares an office with Dr. Powderly. She said at Magnolia, the physicians already screen every child at well-child checkup ages age 12 and up for depression.

“I have found it is a good way to signal to kids and parents that we are open to talk about this and want them to ask us about it,” Dr. Charette said. “Even if on the well check nothing comes up, often a parent will return with the teen later wanting to talk about anxiety and depression. I believe the screen helps open that door and the conversation. I also find for teens that are not having any signs of depression/anxiety and wonder why they are doing the screen it still opens a conversation. I then talk about how it is great that they are doing well but that many kids are not. Parents appreciate this – it helps open why some other kids might be depressed, what can be done to prevent it and helps with empathy for others.”

Justin Smith, M.D., a Cook Children’s pediatrician in Trophy Club and a member of the executive committee for communications and media with the AAP, said new guidelines are important for three reasons:

1. Screening helps to pick up teens who would have otherwise been missed. Signs and symptoms of depression are sometimes seen in kids who might have surprised you.
2. Sometimes children are aware of symptoms that they are feeling that they don’t associate with depression. Asking them direct questions will sometimes highlight a feeling that they have had and give them the opportunity to discuss it.
3. Talking about mental health on a regular basis normalizes the conversation. Even if the child isn’t experiencing problems right now, they begin to learn that our offices are a safe place to discuss their feelings.

More on this topic:

• New Behavioral Health Center Offers Hope for Children In Crisis
• Dealing with Depression
• 7 Signs Your Child May Need Mental Health Help
• 13 Reasons Why You Should Be Concerned Your Child May Attempt Suicide
• Suicide of Elementary School-Aged Children and Adolescents
• 13 Warning Signs of Teen Suicide
• Is Your Teen's Smart Phone Making Them Depressed?

Make sure they get enough sleep.

A new study, published in the Journal of Obesity, found that routines for preschool-aged children are tied to better emotional health and may lower the chances of obesity later.

The American Academy of Sleep, supported by the American Academy of Pediatrics, has released the following recommendations for how much sleep kids, from infants to teens, need based on their age:

• Infants 4 to 12 months – 12 to 16 hours of sleep every 24 hours (including naps).
• Children 1 to 2 years – 11 to 14 hours of sleep every 24 hours (including naps).
• Children 3 to 5 years – 10 to 13 hours of sleep every 24 hours (including naps).
• Children 6 to 12 years -9 to 12 hours of sleep every 24 hours.
• Teens 13 to 18 years – 8 to 10 hours of sleep every 24 hours.

The AAP found that adequate sleep duration for age on a regular basis leads to improved attention, behavior, learning, memory, emotional regulation, quality of life and mental and physical health. Not getting enough sleep each night could mean an increase in injuries, hypertension, obesity and depression, "especially for teens who may experience increased risk of self-harm or suicidal thoughts."

Hilary Pearson, M.D., medical director of the sleep laboratory at Cook Children’s, said parents often set the tone for their child’s sleep patterns.

“One way of protecting your kids’ sleep is protecting your own sleep,” Dr. Pearson said. “Parents should think about how much sleep they get and then recognize how much sleep their children are actually getting. That alone can be very helpful.”

If your child is not sleeping well, Dr. Pearson says most of the time there are simple things that parents can do to make a difference in their kids’ sleep.

“I’m a firm believer in establishing a bedtime and sticking to it. Children who have not reached puberty should be in bed before 9 p.m. Studies show they will sleep better overnight, wake up more easily in the morning and have fewer behavioral problems. A routine that simple could make the difference in whether a child receives good grades at school,” Dr. Pearson said.

The new study, published online and in the April issue of Pediatrics, showed that cribs/mattresses “were the second most common source of injury and were associated with the majority of nursery product-related fatalities.”

The study states that it’s likely that sudden unexpected infant death accounted for many of the fatalities recorded.

“Sleep environment hazards play a key role in infant injury, especially sudden unexpected infant death, and health care practitioners should counsel caregivers to not place bumper pads or soft objects, such as blankets or pillows, in the crib because of the risk of strangulation, entrapment, and suffocation,” reads the article. “Caregivers should only use the firm, snugly fitting mattress designed for their crib and never use supplemental mattresses, which may increase the risk of entrapment and suffocation.”

Since 2011, the American Academy of Pediatrics has recommended against bumper pad use due to the risk of injury.

The study found that nursery product-related injuries were most commonly associated with:

• Baby carriers (19.5 percent)
• Cribs/mattresses (18.6 percent)
• Strollers/carriages (16.5 percent)
• Baby walkers/jumpers exercisers (16.2 percent)

Nearly 1.4 million nursery product-related injuries among children aged 3 and under were treated in emergency departments in the United States during the 21-year study.

During the time span, of the 0.2 percent of injuries that resulted in death:

• 80.2 percent were younger than 1 year old
• 86.9 percent were breathing related
• 73.4 percent were associated with cribs/mattresses

Related Articles:

• When Can My Baby Sleep With A Blanket and Pillow?
• SIDS, Suffocation and Co-Sleeping Dangers
• Safe sleep: Young moms, are you listening?
• What is the Fort Worth Safe Infant Sleep Initiative?
• 8 ways swaddling your baby increases risk of injury or death

Will it give you peace of mind? Will it prevent a bad outcome in your child?The answer is probably…no and no.Newborn technology innovation is driven largely by cashing in on the fears of parents. SIDS is the No. 1 fear of newborn parents. Of course, there will be those that try to capitalize on that fear.

The American Academy of Pediatrics (AAP) recommends against the use of these baby monitors in healthy infants, mainly because there’s no proof they work. A new article in the Journal of the American Medical Association (JAMA) has come out strongly against buying “smart” clothing with vital signs monitors. These monitors attach to your baby’s socks, onesies, buttons … and continually check vital signs like breathing, pulse rate and oxygen levels. If there are any abnormalities, you are notified on your smart phone. The problem is the amount of false alarms that freak out parents.

I know I would be freaked out if we were still in the baby stage. My wife and I no longer have babies at our house (Hallelulah!), and fortunately we got out of that stage before this stuff became popular. We went with the video baby monitor with sound and the ability to talk back. But, even if they were available, I wouldn’t have owned a respiratory monitor. Here’s why:

1. They won’t prevent SIDS. There has never been a study showing that a monitor, even a fancy hospital issued monitor prevents SIDS or any other negative health outcome. Particularly not in healthy babies.
2. It “medicalizes” sleep and safety. Ok, so I made that word up. But sleep is a normal process. Safety is something you do your best at but you can’t control for everything.
3. It would tempt me to do unsafe things with my baby thinking I had another layer of protection. Well, maybe not me because I’m the back-to-sleep-nothing-soft-even-crib-bumpers-and-stuffed-animals guy. But, someone might be tempted to.
4. I know what prevents SIDS. And it’s not a monitor. (See No. 3 above.)
5. I would be a nervous wreck. And not just me, but for my wife too. Every false alarm would literally lead to a whole night of missed sleep. I was crazy enough with the video monitor. Did you see that? Did she just move her leg a little?

So for me, it’s not time to be buying respiratory or other fancy monitors for your newborn. If you want to, whatevs. Go for it, but just know that it’s not completely benign.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.

Have you seen or talked to them since?

Whether it’s a phone, a tablet or the TV, there’s no denying that the use of screens and media have changed childhood and parenting. Do you have a child that seems addicted to their screen?

With any change, there is potential good and potential harm. The American Academy of Pediatrics (AAP) has changed their stance recently based on the current state of research on the use of screen time on children and adolescents.

If you have time (and are a little nerdy), I strongly recommend that you read them:

Media and Young Minds

Media Use in School-Aged Children and Adolescents

Children and Adolescents and Digital Media

It’s a total of about 30 pages of work. But, given the current state of how these affect our children and parenting styles, and the practice of pediatrics, there are fewer more important papers you could read.

AAP reccomendations include limiting screen time to 1 hour per day of for children 2 to 5 years of age. For kids 6 and older, be consistent with the amount of time looking at the screen and don't let it interfere with sleep, physical activity and other activities essential to good health.

In case you don’t have time, here are 11 key facts you should know about the new guidelines:

1. The average age children interact with media in 1970: 4 years; Today - 4 months.

2. You have to teach your toddler to talk, a device can't. Limit solo screen time until 2 years of age.

3.Under 18 months = Video Chat Only. 18-24 months = Choose high quality apps and play with child. Reteach what they are learning if you want any benefit.

4.Children must learn to sooth themselves without a screen. Don’t hand the phone over at the first sign of trouble.

5.Screen free zones are critical = 1) Dinner 2) Meal times 3) Bedroom 4) During play time (yes, parent, that means your phone too).

6.Media use is not ALL bad in teenagers: 1) Knowledge 2) Collaboration 3) Social support

7.Media use and overuse in teens can lead to many problems: 1) Obesity 2) Poor sleep 3) Problematic internet/gaming (addiction).

8.Is monitoring your teen's phone/device enough? No. You can't see/watch everything. You must teach them core values as well.

9.It’s not just kids struggling with these issues. Distracted parenting is a real problem as well across child ages.

10.If you want to succeed in this struggle, you must have a plan. Try out this great free tool from @AmerAcadPeds : http://www.healthychildren.org/MediaUsePlan

11.Just because an app or show is listed as educational, doesn't mean that it is ... do your own research and watch/play with child first.

The American Academy of Pediatrics (AAP) says that while hyperactive behavior can be considered normal for some children, hyperactivity can, but doesn’t have to, be indicative of a neurological-developmental condition, such as ADHD.

ADHD is a diagnosis given when a person shows a persistent pattern of inattention and/or hyperactivity-impulsivity that negatively impacts his or her life.

“A hyperactive child is one who is more physically and/or verbally active than other children his or her age,” said Carolyn Cruse, PsyD, a licensed psychologist at Cook Children’s. “It is important to remember that what qualifies as hyperactivity in one age group may not be called hyperactivity in another.”

In addition, it's crucial for parents to note that having a hyperactive child does not necessarily mean the child has ADHD. When hyperactivity presents as a single symptom, it’s probably incorrect to assume the child has ADHD.

There are different subtypes of ADHD that could be part of a child’s diagnosis:

• Predominantly Inattentive Type - only symptoms of inattention are present and there are no or very few symptoms of hyperactivity.

• ADHD Predominantly Hyperactive-Impulsive Type- mainly symptoms of hyperactivity-impulsivity and a few symptoms of inattention.

• ADHD Combined Type - symptoms of both inattention and hyperactivity-impulsivity.

What Is Hyperactivity?

Hyperactivity shows itself in children as talking excessively, fidgeting or squirming in their seat at school or church, running or wandering when expected to walk or be still and having trouble sitting still for calm leisure activities like coloring or doing puzzles.

Parents sometimes describe their hyperactive children as constantly in motion or always on the go. The overactivity should be more than what is typically seen in other children that age and should negatively impact the child’s ability to function in school, home or other situations in order for it to be considered an indicator of ADHD. Thus, hyperactivity may be the first concern that is noted by parents or teachers.

“Parents should be concerned when their child’s overactivity is negatively affecting his or her ability to learn and behave appropriately in school, complete homework or follow the rules at home and/or participate in extracurricular activities,” Cruse said.

For example, a 5-year-old girl who is starting kindergarten may be observed having trouble sitting still in her seat and constantly wandering the room during “circle time,” but this would generally be seen as age appropriate. However a 7-year-old second grader who moves so much that he falls out of his chair and repeatedly gets out of his seat when he should be completing class work is more likely displaying symptoms of hyperactivity.

Hyperactivity can be seen in very young children or toddlers, but a diagnosis of ADHD should be made cautiously. In very young children, hyperactivity may appear as though the child is having difficulty functioning at home or school. These children are constantly shifting from activity to activity, jumping on furniture, climbing up cabinets and unable to sit still—even briefly—for quiet activities.

Again, the overactivity should be more than what is seen in other children their age. Younger children are also likely to display their hyperactivity and impulsivity as aggressive behavior. These children have not fully learned to respond appropriately to frustration or irritability and may impulsively respond with aggression. Older hyperactive children may also behave aggressively because of their hyperactive/impulsive tendencies.

Hyperactivity is seen in both boys and girls, though boys are more likely to experience hyperactivity at a heightened level that indicates ADHD, according to Cruse.

What Can You Do?

A hyperactive child will benefit from the chance to hand out papers in class, take a note to the teacher in the next room or simply walk to get a drink from the drinking fountain every so often.

Some hyperactive children actually function better when allowed to stand at their desk rather than sit. This cuts down on fidgeting and squirming in the chair. Parents may need to let their child have a chance to run and play once he or she get home from school to release pent up energy before starting chores or homework.

Parents can channel their hyperactive child’s energy into positive outlets such as sports, dance or karate. They can also use their child’s energy by making games out of small chores (make putting away toys a beat-the-clock game, putting laundry in the washing machine into a basketball game or sweeping the floor as a dance routine).

“Hyperactive children are often seen as very charismatic and fun-loving,” said Cruse. “They can often find fun in whatever they are doing and tend to be creative. When that hyperactivity is channeled appropriately, these children can grow up to be very high-achieving adults.”

Getting a Diagnosis

If parents believe their children’s hyperactivity is severe enough to be interfering with their daily functioning, and increasing their children’s involvement in appropriate physical activities has not improved the problem, they can contact their pediatrician or Cook Children’s Psychology department regarding a possible evaluation for ADHD.

Once a diagnosis of ADHD has been made, there are various treatment options to help improve a child’s functioning. A therapist/psychologist can help by teaching children to monitor their own behavior and learn to think before acting. They can also help parents learn more effective ways to handle their child’s hyperactivity. Schools can also make accommodations that will help with school performance.

Finally, medication is another treatment option that parents can discuss with their pediatrician or a child psychiatrist.

Parents using dosing cups had four times the odds of making a dosing error, compared to when they used an oral syringe and that the most common mistake was overdosing: 68 percent of the participants gave too much medicine, rather than too little.

Children should receive their liquid medications only through milliliters to reduce dosing errors, according to a policy statement from the American Academy of Pediatrics. The AAP recommends medicine to children be administered by a syringe with flow restrictions, but cups and spoons are acceptable, as long as the dosage is marked in milliliters.

The AAP’s research found that more than 70,000 children went to the emergency room because of unintentional medication overdoses.

The AAP says parents should not be using household spoons or any other measuring device to give kids their medicine, other than measuring in milliliters (mL).

“Sadly, some may feel that liquid medication accuracy just isn’t very important. They may think, ‘It’s just cough syrup or to reduce fever,’” said Jason Evans, a pharmacist at Cook Children’s. “While an adult may be able to tolerate a huge discrepancy from a dessert spoon, a child can be seriously hurt or even killed. There have been several children fatally overdosed in this manner from mere cold medication. “

Household spoons simply aren’t accurate. Three teaspoons are in one tablespoon and a household teaspoon can vary in size. Depending on the spoon, a parent can give a child as little as 2 mL and much as 8 mL, when the intended dose was actually 5 mL. That large discrepancy is the danger that has made the AAP take this stance.

Evans said most hospitals have been using the mL standard for 10 to 20 years because it’s a much safer practice and avoids errors. Cook Children’s follows the mL system, even for oral syringes.

“We don’t have teaspoon or tablespoon markings anywhere,” Evans said. “Syringes are more accurate than dosing spoons and dosing cups. There is scientific evidence for this. Now, we just need to complete the puzzle and use the same terminology for patients at home.”

Evans gives the following advice to parents:

• Know your child’s medication in terms of the metric system.
• Ask your pharmacy for a medication syringe, not a dosing spoon or cup.
• Use a medication syringe, even if a dropper came with your prescription.
• Ask for a bottle adapter that will allow you to turn the bottle upside down to draw out the medication.
• Hand wash syringes to avoid melting or rubbing the markings off.
• Ask your pediatrician or pharmacist if you are confused about how much medication to give.
• It might not just be the parent giving the medications. If necessary, have your babysitter or other caregivers (e.g. grandparents) demonstrate to you how to measure the medication with the syringe.

Read more from the American Academy of Pediatrics on this topic here.

“What have you been up to this summer? Did you play outside at all or has it been all video games?”

“Pretty much video games.”

“Oh cool, what kind of games do you like? Sports?”

“No, stuff like Call of Duty and Grand Theft Auto.”

It would be one thing if I was having this conversation with a teenager (still not ideal) but this CHILD was 7 years old.

Twenty years ago, considering TV alone, a study estimated that children see 8,000 murders and 100,000 acts of violence before middle school. With the TV, movies, social media and video games available today, there is no telling what that number would equal.

Studies are clear that exposure to virtual violence increases aggressive behavior and thoughts. Yet, the means by which children can be exposed to virtual violence seem to increase exponentially every year. A recent statement from the American Academy of Pediatrics encouraged pediatricians to talk with families about virtual violence and to provide guidance for how to address virtual violence in well-child visits. I read through it and, frankly, was tempted to throw it out with some of the other policy statements, etc. that I don’t think apply to me. Here are four reasons why I NEARLY ignored the new virtual violence policy statement:

1. I have too much to do in a checkup as it is. It’s true that there are a lot of things to cover in a checkup and it’s possible that I won’t get to the topic of virtual violence every time, but when I can I should.

2. Kids are dealing with real-life violence. I work in a clinic where tragically, for some kids, being exposed to virtual violence might be a good day for them. Again, we need to provide the best possible pediatric care for the patient in front of us. If a child needs to be physically safe that should take priority but if, for another, virtual violence is their biggest risk, we should address that as well.

3. Kids have started with violent media before I even get a chance. See conversation above. This may be a real concern, but it means that I should start the conversation earlier, not ignore it all together.

4. Parents who let their kids be exposed probably don’t care about what I have to say about it. It’s possible that one parent is concerned and the other not. Perhaps my information and support might be enough to cut down on or eliminate virtual violence exposure.

I’ve always had casual conversation about media with my patients. Despite my reluctance to focus on this, I think it’s an important piece of information for parents to consider for their children. Here are some tips that you can use to help decrease you child’s exposure to virtual violence:

1. Start early engagement with your child about screen time and habits. If you let your child watch unlimited screen time as a one year old, imposing strict restrictions on anything related to screens later only gets harder.

2. Co-watch almost everything with your child. I get it. I’m a parent and I’m tired of watching kid shows. I’d rather be on Twitter. But if there’s anything new or potentially risky, I watch it or play it with my kids.

3. Don't let your child play first person shooter games or any game where the goal is violence or killing. They don't have the ability to separate real vs. virtual violence and their growing and developing brains cannot handle that level of exposure.

The AAP (American Academy of Pediatrics) and the Centers for Disease Control’s ACIP (Advisory Committee on Immunization Practices) stated, “Health care providers should not use live attenuated influenza vaccine (LAIV) in the upcoming 2016-2017 season due to poor effectiveness.”

The first thought that went through my head was this: my kids have to get the injectable flu vaccine next year AND I have to convince them that it’s a good thing. (I may be a pediatrician, but I’m still a dad.)

The committee looked at data from the last three flu seasons showing that the nasal vaccine had limited to no effectiveness for preventing flu.

Here are 4 facts you need to know:

1. Even in bad years, the flu vaccine continues to provide the best layer of protection against this deadly disease. Last year’s injectable flu vaccine was 50 percent effective in preventing disease which means thousands of people were protected.
2. Assuming there’s no new information or guidance, your pediatrician should not offer your child the nasal flu vaccine. Even if we hear something new, I would choose to do the injectable vaccine and I will do so for my kids.
3. The committee is hopeful that this early decision will help prevent any issue with the vaccine supply. However, there are flu vaccine supply issues nearly every year so I recommend getting in to get your shot early.
4. There’s a committee out there who is looking at this data and making the best recommendations possible based on the latest information. Is it frustrating that we were giving a vaccine that didn’t work? Of course. Am I glad that I won’t do it for another year? Definitely.

Stay tuned for more information about flu and flu vaccines as we get closer to September when flu vaccine supplies start arriving at your Cook Children’s pediatrician’s offices.

About the author

Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Ft. Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in the fall of 2016.

“This is not fun!”

“I don’t want to play anymore.”

Are these lines you’ve heard your young athlete say? Have you found yourself asking questions like – “What could cause a talented, young athlete to lose their passion for playing a sport?” “Or why would they throw everything away after we’ve worked so hard?”

Your young athlete may be feeling a sense of overtraining or burnout from their sport.

What is overtraining or burnout?

Overtraining occurs when an athlete does the same skill over and over again with limited rest, causing a loss of enjoyment or withdrawal due to increasing physical demands. This could be specialization in one sport, high volumes of training, or demands of coaches, trainers, parents, or self to achieve a specific skill level, time, or score in their sport. A child may sense these demands as too much, leading to physiological and mood changes affecting self-esteem, levels of stress and ultimately leading to physical and emotional exhaustion.

Overtraining can also increase your child’s risk for injury. Often young athletes are putting in long hours to perfect their sport and participate in competitions or tournaments. This repetitive stress and physical exhaustion on a growing, undeveloped body can promote weakness and breakdown of body support structures, placing the athlete at risk for overuse or repetitive stress injuries. A study performed by the American Academy of Pediatrics (AAP) found that athletes who spend more than twice as much time in sports than in free play, who intensely specialize in a single sport, or who played more hours per week than their age, are more likely to have overuse injuries and potential emotional burnout.

Not all athletes that request to stop a sport are burned out. Some request to stop due to time constraints, interest in trying something new, lack of playing time, or boredom. That is why it’s important to be aware of signs of burnout or overtraining.

What are some causes of overtraining/burnout?

• Early specialization in a sport
• Lack of rest
• Lack of life balance
• Loss of fun
• Excessive negative or unclear feedback from coaches and/or parents
• Poor relationship with coach or teammates

What are signs of overtraining?

• Loss of desire to play
• Tiring quickly
• Resisting working with coaches and teammates
• Not reaching training goals
• Chronic injuries

What can I do to help?

It is important to switch focus back to the fun of the game. This can happen by starting pick-up games and reducing the pressure to exceed. This transitions the focus to building teamwork, bringing awareness to proper fitness and health, developing friendships, and having fun.

As the athlete’s parent, you are their support system and second voice. Talk to your athlete and their coach about promoting a good life balance and placing fun back into the game. For example, recommend reducing the number of competitions if your child is training 6-7 days a week for multiple hours a day.

What if you’re the parent and coach? Children model those around them. Teach them based on how you conduct yourself in your passion for the sport, the importance of life balance and rest, and how to create open lines of communication with teammates and coaching staff. Reward the positives, but also use the negatives for learning experiences and education.

Change the mindset of “win-at-all-costs” and motivating through a focus on winning, humiliation/anger when they fail, or pressure to get the athletes mind back in the game. Instead, promote a positive atmosphere where there is a balance of the serious, competitive side and fun side. Try to regain the fun, or positively support and guide them as they transition interest to another sport, position, or activity. There is even a possibility that through this process of finding their passion, they might return to that same sport because they want to, not because they were forced. Also, by reducing the monotony of training and allowing your child to try different sports or positions, you can promote varying levels of strengthening, muscle memory, and physical and mental growth.

It is important to be aware that it is OK for an athlete to become serious about their sport and invest time and energy into pursuing their sporting goals as long as they maintain a passion for what they’re doing. If the passion and fun for the sport is removed, there is a risk for heartache, unhappiness and ultimately burnout.

More resources from the Cook Children's Sports Performance Orthopedic Rehab Team Specialists (SPORTS):

• The basics of sports injury prevention for kids
• Rise of overuse injuries in school-age athletes 
• Top 10 questions parents have about sport injuries
• Young athlete’s injury prevention guide

About the author

Jenny Arey, PT, DPT, OCS, CMPT, is a SPORTS physical therapist. She's a board certified orthopedic clinical specialist and certified manual physical therapist. The SPORTS Program at Cook Children’s offers educational material for parents, coaches, trainers and nurses for sports-specific injuries. Our team of experts have specialized training in pediatrics and collaborate together to share their knowledge in growing bodies and dynamic training principles. 

At best, the mom is rolling her eyes and pulling her phone out to hand to her screaming child.

“Children under 2 years of age should have no screen time and after 2 years, we should limit screen time to 2 hours per day.”

There is the common summary statement that can be taken out of the AAP Policy Statement on Children, Adolescents and the Media.

Is this realistic?

Is this practical?

Is anyone listening to anything we say?

In May, a meeting of the best minds in the use of media in pediatrics set out to answer these questions as well as look at recent research on the use of screens in children and teenagers.

In order to get information about the meeting out quickly, AAP News released a summary of some of the thoughts that came out of the meeting.

If you read the headlines that were generated as a result of the statement, you might have heard:

“Pediatricians think all screen time is OK. Go for it!”

“Pediatricians finally admit that they were dead wrong and outdated when they said toddlers shouldn’t use screens.”

“Pediatric guidelines now changed to allow for more screen time, at earlier ages.”

Unfortunately, we don’t always get the time to fully explain our message and the media doesn’t always get it right.

Here are my takeaways from the statement that I hope better reflect the intent of the authors:

1. What you might have heard: “Pediatricians think all screen time is OK. Go for it!”

What it should have said: “We need to continue to be careful about the amount of time children are on screens. Guiding them toward quality apps and games that are more than just watching a video is important. Watching and playing alongside your children helps to enrich the experience for the family as a whole.”

2. What you might have heard: “Pediatricians finally admit that they were dead wrong and outdated when they said toddlers shouldn’t use screens.”

What it should have said: “The benefit of screen time for toddlers is an ongoing topic of research but it is clear that children continue to learn best from interacting with and talking to other humans. One of the major risk of screen time is the time take away from rich interaction with parents and other caregivers.”

3. What you might have heard: “Pediatric guidelines now changed to allow for more screen time, at earlier ages.”

What it should have said: “While this statement is not a new guideline, it does highlight the AAP commitment to following new research in regards to screen use and helping to relay that information to parents as soon as possible. As more information comes available, we will update our guidelines to reflect current studies in the context of practical media use for children.

Do continue to follow this debate because the guidelines are likely to change over time. (P.S. That’s what guidelines should do in a new and heavily researched field.)

Don’t go out and buy your 1 year old her own iPad.

In an article published in “Pediatrics,” the AAP says, “no alcohol intake should be considered safe” during pregnancy” and “there is no safe trimester to drink alcohol.”

Key points from the AAP include:

• Alcohol-related birth defects and developmental disabilities are completely preventable when pregnant women abstain from alcohol use.
• Neurocognitive and behavioral problems resulting from prenatal alcohol exposure are lifelong.
• Early recognition, diagnosis, and therapy for any condition along the Fetal alcohol spectrum disorder( FASD) continuum can result in improved outcomes.

During pregnancy, the AAP says:

• No amount of alcohol intake should be considered safe;
• There is no safe trimester to drink alcohol;
• All forms of alcohol, such as beer, wine, and liquor, pose similar risk.
• Binge drinking poses dose-related risk to the developing fetus.

“Vaccinations are still the best answer to preventing the flu and protecting your children from the upcoming season,” Dr. Whitworth said.

The flu shot is recommended for children ages 6 months and older. However, the Centers for Disease Control says only 47 percent of the nation’s eligible population received a flu shot. The only age group that met the CDC’s coverage goal of at least 70 percent was children 6 months to 23 months of age with 75 percent getting their shot.

It’s important for babies to get their shots beginning at 6 months of age. Flu shots are not approved for younger infants,” Dr. Whitworth said. “Because these younger babies cannot be protected by getting flu shots, their caregivers and household contacts must get theirs. If those individuals who are around the baby don’t get infected with influenza, the baby is much less likely to be exposed. It’s especially important for pregnant women to get their vaccines in order to protect their newborns.”

Last year, a lot of talk focused on how ineffective the flu vaccine was, with the CDC saying it was less than 23 percent effective against the dominant strain. The CDC says the vaccine will be more effective this year based on data from early detected cases.

Dr. Whitworth says it’s too soon to predict what the flu season will bring as far as severity and it’s difficult to say how effective the vaccine will be because different strains circulate each year. But vaccines are still the most effective way to fight against the flu.

During the 2014-2015 flu season, 145 children died in the United States from influenza-related illness and the American Academy of Pediatrics says many of those children had no underlying medical condition. The AAP states that an estimated 90 percent of pediatric deaths have occurred in unvaccinated children.

Two types of influenza vaccines are available for children this year, according to the AAP:

• The inactivated influenza vaccine (IIV) is given by injection and is approved for children 6 months of age and older. It is available in two types, one which protects against three strains and one which protects against four strains of influenza.
• Also available is the live attenuated influenza vaccine (LAIV), which is given by intranasal spray. It is approved for healthy patients 2 through 49 years of age and protects against four strains of influenza.

 The AAP also recommends:

• Everyone who is 6 months of age and older should receive annual influenza vaccine.
• Children ages 6 months through 8 years need two doses this flu season, if they have had less than 2 doses of flu vaccine before July 2015.
• Special efforts should be made to vaccinate household contacts and out-of-home caregivers of children with high-risk conditions, and all children under the age of 5.
• Parents should not delay immunization in order to receive a specific vaccine formulation. It is more important to be vaccinated at the earliest opportunity.
• Pregnant women, who are at high risk of influenza complications, can safely receive influenza vaccine at any time during pregnancy. This also provides protection for their infants during their first 6 months of life.
• Mandatory influenza immunization programs for all health care personnel should be implemented nationwide.

About the source

Mary Suzanne Whitworth, M.D. is the medical director of Infectious Diseases at Cook Children’s, which offers care for children and teens with diseases caused by bacteria, parasites, fungi or viruses. Our team provides a broad range of services including diagnosis, inpatient and outpatient consultations, immune deficiency evaluations and treatment of recurring infections.

Unfortunately, it’s also a troubling trend among today’s high school athletes.

Cook Children’s pediatrician David H. Goff, M.D., FAAP, calls overstressed, busy children a huge problem – both in the classroom and on the playing field. In his Denton office, Dr. Goff sees patients who suffer from a variety of symptoms like chronic abdominal pain, anxiety and depression.

“I see this over and over. I look in the child’s eyes. They are exhausted. I say to the parents, ‘You need to cut back,’” Dr. Goff said. “And it is amazing to me. They say, ‘We can’t. No way. We have a tournament this weekend.’ For any successes we have, we have 100 more burnouts.”

The American Academy of Pediatrics agrees with Dr. Goff. A group of eight organizations, including the AAP, released a consensus statement regarding their concern with today’s high school athlete.

The AAP states, “Student athletes report higher rates of sleep disturbances, loss of appetite, mood disturbances, short tempers and inability to concentrate than non-athletes.”

The recommendations focused on the importance of educating students, parents and coaches on mental disorders in student-athletes; the stress involved with today’s athletes and ways to monitor their behavior.

Concerns of the AAP included the injuries and stress related to student athletes training year round, which doesn’t give them time to rest and recover.

The AAP said these athletes also face stress from poor performance on the playing field, injuries, concerns about getting cut from the team and trouble keeping up with school work, along with their extracurricular activities.

Because of the stress involved, student-athletes may suffer from “a pattern of lack of sleep and under-recovery” and chronic fatigue that puts him or her at risk for anxiety and depression. Other issues include:

• Physical (Physical conditioning, injuries, environmental conditions)
• Mental (Game strategy, meeting coaches’ expectations, attention from media and fellow students, time spent in sport, community-service requirements, and less personal and family time)
• Academic (classes, study time, projects, papers, examinations, attaining and maintaining the required grade point average to remain on the team, and earning and maintaining a collegiate or academic scholarship).

David Gray, M.D., medical director of Cook Children’s Orthopedics and SPORTS, agrees with Dr. Goff that too much activity can simply be harmful to a young person.

With the advent of select sports and recreational leagues, Dr. Gray said children now play the same sport year round without getting a break from those activities. He wants young athletes to have variation in their activities. If not, the repetitive nature of the same sport creates stress and strain especially on growing bones.

Dr. Gray and his colleagues see children who never have a break during the year sometimes playing on two or three different teams during the same season. He said it’s too much stress on their growing skeleton, causing muscle aches, strains and pain.

Both Dr. Gray and Dr. Goff stress children, especially before they reach high school, should focus on participating in several different sports to prevent using the same muscles year round. They say it also helps the child avoid getting burned out on that specific sport.

“For kids, sports are great and you learn a lot from them, but they should be fun,” Dr. Gray said. “Kids need to enjoy them too. You don’t really want a 12 or 13 year old performing to the point where they are having injuries that could actually impact them as an adult.”

Dr. Goff admits this subject quickly places him on his soapbox. But it’s because he sees so many of his patients facing stress and are simply not happy.

He sees them come in with dark circles under their eyes and behind closed doors and just one-on-one with him, they admit to a different story than what they have been telling to their parents.

Far too often, Dr. Goff hears the regrets of parents, but only when it’s too late. The child has gone off to college and the parent wishes they had taken a trip to the Grand Canyon with their family, instead of racing off to another game.

“I ask the parents to leave the room so I can talk to the child,” Dr. Goff said. “I ask, ‘Do you really want to do this?” They say, ‘No I’m tired.”

The scary part of this story is that far too often the parents are trying to do what’s best for their child, but in reality they are doing harm.

Dr. Gray said he is beginning to see injuries in children as young as 8 years old with ACL injuries. Injuries that were once thought not to happen until children were much older.

“Another problem is that the really good, young kids are getting left behind,” Dr. Gray said. “They are burned out because they are pegged to be the superstar and they get over worked, over trained and over pushed. Some get burned out and pushed to the wayside and other kids, who were not as big, catch up by the time they are in middle school. They have more passion and they are not burned out. And they pass them by.”

Both Dr. Gray and Dr. Goff also see phantom injuries – muscle aches or headaches. Anatomically there seems to be nothing wrong with the child. In reality it’s the child hinting he or she needs a break.

So what should a parent do? Here’s a start:

• During the year give the child down time and a chance to recuperate. This is the case physically for sports and mentally for school.

• Vary the child’s routine to avoid burnout

• Give your children an opportunity to tell you if they are enjoying themselves.

“It’s easy to succumb to parental peer pressure,” Dr. Gray said. “Parents are afraid if they don’t do something their child will be left behind. What’s most important is that your children enjoy sports, or enjoy their activities and has a good mental outlook on life. It’s hard for parents to not live vicariously through their children. It’s a hard lesson for parents. You want the best for your child and want your child to be successful. But sometimes less is more.”

If you don’t know her name, you more than likely have seen her photo because she has blown up the Internet with a photo of her breastfeeding her own son and the son of a friend.

For some it’s a beautiful expression of what’s perfectly natural. For others, it’s caused a range of emotion from “yuck” to outrage.

And for our lactation experts at Cook Children’s, well, they look at it as an opportunity to educate the public.

The lactation nurses at Cook Children’s have been busy working and had not seen the photo making the Internet rounds until called for this story. They realize that it makes many of us uncomfortable in the United States to see such a bold expression of a natural process. But they say it’s a common practice in many other countries around the world and accepted and sometimes expected culturally.

From a medical aspect, the lactation experts say milk sharing is becoming a more common practice but not without risks. There are numerous transmittable diseases that can be passed on through a mother's milk as well as many medications that will be passed on through milk too. As milk sharing is becoming more common there are even websites out there where people can share breastmilk with one another. Again, caution must be used when sharing breast milk.

To be perfectly safe, for those babies that have a medical need and prescription for breastmilk, they recommend a place like Mothers’ Milk Bank of North Texas, which allows moms to donate breastmilk. The mothers go through a screening process and is then the milk is pasteurized to make sure there’s no harmful bacteria.

The consultants hope that people don’t focus on the photo as much as they do the benefits of breastfeeding.

And for those of you wondering, “Aren’t those kids a little old to be breastfeeding?” Come on. We know a lot of you are. The World Health Organization recommends breastfeeding babies until at least 2 years of age.

The lactation nurses aren’t willing to weigh in as far as the emotional aspect of the picture or how it impacts them developmentally. Breastfeeding in a personal choice and one that we hope every mother will attempt. How long to feed your baby is personal and will be very different for each mother. At the end of the day, breastfeeding is supported by the World Health Organization, Center for Disease Control, the American Academy of Pediatrics just to name a few.

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of a baby’s life, “followed by breastfeeding in combination with the introduction of complimentary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.”

About the source

Because research shows that breast feeding helps improve babies' health and helps moms bond with their little ones, Cook Children's has full-time lactation specialists on staff to assist mothers with pumping and breastfeeding. We offer breast pumps in every room and have an on-site milk bank available for safety and storage. There are numerous resources available through lactation services for moms that are having difficulty with nursing/pumping. While other nurses are focusing on the baby's care, the lactation consultant can provide extra attention to mom.

You decide to seek out some information online and you find this:

“Although data to make specific recommendations as to when it is safe for infants to sleep in the prone or side position are lacking, studies that have established prone and side sleeping as risk factors for SIDS include infants up to 1 year of age. Therefore, infants should continue to be placed supine until 1 year of age. Once an infant can roll from supine to prone and from prone to supine, the infant can be allowed to remain in the sleep position that he or she assumes.”

AAP SIDS and Safe Sleep Guidelines

“Heh?”

Hopefully none of us really talk this way, but I have a feeling sometimes it’s close. Doctors have a notoriously bad rap for their handwriting; fortunately, we’ve mostly fixed that with electronic records. Unfortunately, some of us aren’t known for our amazing verbal communication skills, either.

A study released in Pediatrics this week highlighted this fact. The authors surveyed mothers of 4-6 months old babies about the education they received from their doctor when their baby was a newborn.

They asked the mom if they received advice on the following topics: vaccination, breastfeeding, sleep position, sleep location and pacifier use.

All of these seem like pretty basic newborn information. Most doctors would want to cover them during that time frame. They all are included in very specific guidelines with clear instructions for how the American Academy of Pediatrics wants us to educate our patients?

How did the doctors do? The following percentages reflect the number of mother’s who reported receiving correct advice for the respective topics:

1. Does it seem like we’re speaking in a foreign language?

For many cases, the study showed that either the doctors failed to mention some pretty important topics or they weren’t presented in a way that parents understood or remembered.

One of the reasons I love to write is that it forces me to have clear thoughts about the medical issues I deal with every day and to focus on clear strategies for communicating those thoughts to patients. Of course, I’m not perfect. Here are some of the communication mistakes I (and from the results of this study, other doctors) make and some strategies for the way things should go (with help from you of course):

Some people describe the first few years of medical school as being more or less a foreign language study. During those years, medical students learn terms that most people don’t need to know. We use them as a way to communicate with other doctors as we begin to learn from “real” patients in the later years. The problem is we sometimes forget that we can’t talk that way all the time if we want to be understood by our families.

How can you help us while we work to get better?

Don’t be afraid to ask questions or to stop us if you don’t understand. Your child’s health is important to us. We know that you have to understand our instructions if we want to have any chance to help your child stay healthy or get better when they are sick. Ask us to slow down or to re-explain a certain concept again if what we say doesn’t make sense.

2. Have we given you the best opportunity to hear us?

This newborn study is a perfect example of this. A newborn mom is tired and stressed and getting health advice from the nurse, the doctor, their family and the Internet, so what usually ends up happening? We rush right through with the messages that are important to us and hope that mom gets them in 5 minutes.

Thanks for coming in. Good luck, mom!

Other examples are when we deliver bad news or just simply have a baby with an ear infection that is screaming in pain while we get louder and louder to make sure we are “heard.”

How can you help us while we work to get better?

Some are easier than others. When we’ve delivered bad news, there’s probably nothing either of us can do to help in that situation. But we should definitely slow down and wait a minute to let you think before we plow through into “next steps.”

If your baby is fussy and you can’t concentrate, feel free to ask if a nurse could come help for a second while we talk. Even if the baby stays in the room, just having them out of your arms makes it easier to listen. During those newborn visits when you are sleep deprived, ask for resources that you can take home and read when your mind is a little more clear (if that every actually happens for any of us with newborns).

3. We try to cover everything, but did we focus on what you want to learn?

This has another medical school analogy. Some people refer to the first few years of medical school as “trying to drink from a firehose.” There is so much information coming so quickly, you have to learn how to decide what is important enough to waste brain space on and what can be discarded (or “Googled”) later. So, when it comes to giving advice, we assume that you can do the same. The other assumption we make is that you actually care about the things that are important to us.

How can you help us while we work to get better?

First and foremost, please bring a list of questions. This helps us to focus on the things that are important to you, which are the things that you are going to remember anyway. As I get to know my “listers” better, I tend to grab (nicely) the list out of their hands and start writing the answers down (in ugly doctor scrawl) as we go along.

This is another time when asking for resources can be really helpful. Ask us to highlight or point out sections that are related to what you have talked about in the visit. Now, for this strategy to work, the resources have to come out of the diaper bag before they get formula and other baby fluids spilled on them - better yet, maybe they can just be pulled up on your phone …

I work hard to avoid these mistakes. But as I said, I’m not perfect. Communication is vital between a pediatrician and a parent. In the medical community, it looks like we have a lot of work to do.

Fortunately, we have some great examples at Cook Children’s to learn from.

But we can all get better with your help and feedback.

“Hey bud, how did you get that BAND-AID^®?”

“I just climbed up on this and got it (from the medicine cabinet).”

Those are 2 conversations that happen frequently and just yesterday, respectively, in my house.

A study released this month in Pediatrics (the journal of the American Academy of Pediatrics) looked at out-of-hospital medication errors in patients less than 6 years of age.

There were many questions that the study looked to answer:

How common are medication errors?

Almost 700,000 errors in these children over the 10 year period, that is equal to 1 error every 8 minutes.

Many of these were minor and required no medical care, but there were almost 2,000 children who required intensive care and 25 death due to medication errors.

What type of medications were associated with more errors?

Liquid medications were the most common, accounting for 81.9% of the errors. These kids are more likely to be taking liquid medications so this might be expected but it’s still a good reminder we need to be cautious.

Where do the ingestions occur?

The child’s own home was the location of the ingestions 96.9% of the time.

What errors were the most common?

The 5 most common errors were:

1. Medication accidentally given twice.
2. Confused the units of measure (1  milliliters (mL) vs 1 teaspoon (tsp).
3. Wrong medication taken/given.
4. Medication given too soon.
5. Accidentally was given or took someone else’s medicine.

So what can you do to protect your child?

1. Be aware. These errors are common and we need to be aware.
2. Be cautious with liquid medications. Kids can find and ingest them more easily and dosing errors are more common.
3. Protect your own home. Make sure that medications are locked away in a safe place.
4. Double, triple and quadruple check your dosing. You know the saying measure twice and cut once? For meds it should be measure 5x and give once.
5. Assign a primary medication giver for the house. If anyone else is giving meds, run it through them first.

If you are having even the slightest trouble, questions or concerns regarding your child’s safety in the car, certified child passenger safety technicians are able to help or even double check your work.

For those of you in the Tarrant County area, you can call Safe Kids Tarrant County, led by Cook Children’s, at 682-885-2634.  Also visit this site for a quick car seat checklist with the top 5 things to do to check your seat. 

1. When can my child change from rear-facing to forward-facing?

The American Academy of Pediatrics (AAP) recommends children ride rear-facing until at least 2 years old or until they reach the maximum height and weight for their seat. Keeping children in a rear-facing position better protects their heads, necks, and backs. Seats will indicate on the side labels what the rear-facing weight/height limit is and you can also check the manual of the seat. Parents often worry about the safety of a child’s legs when the child is growing taller and is still rear-facing.  Studies show that a child’s legs are actually injured less often when a child is rear-facing.  Both of my children were in the 90+ percentiles for height at age 2 and both remained rear-facing past 2 years old.

2. When can my child use a booster seat instead of a harness forward-facing seat?

The AAP recommends children ride in car seats with a harness until at least 4 years old, however they should continue to use a 5-point harness up to the highest weight or height allowed by the manufacturer of the seat.  Moving from a 5-point harness to a booster seat is a step down in safety, so a child should remain in the harness seat as long as possible.

3. When does my child no longer need to use a booster seat?

Texas law requires children to remain in booster seats until at least age 8, unless the child reaches a height of 4 feet, 9 inches before age 8 (which is extremely uncommon). 

Recommendations state a child should remain in a booster seat until at least age 8 or until the seat belt fits correctly. Most children are 9 years or older before they reach 4 feet, 9 inches, which is when the seat belt will usually fit them correctly without the booster seat. You can use the “Safety Belt Fit Test” to help you determine if your child is ready to use the seat belt alone without a booster seat:

1. Have your child sit all the way back on the vehicle seat.  Do the knees bend at the front edge of the seat?  If no, then your child should stay in a booster seat.  If yes, then go to No. 2.
2. Buckle the seat belt.  Does the lap belt lie on the upper legs or hips (not the stomach)?  If no, then your child should stay in a booster seat. If yes, then go to No. 3.
3. Does the shoulder belt rest on the shoulder or outer collar bone (not the neck)?  [Note- Never put the shoulder belt under a child’s arm or behind a child’s back.]  If no, then your child should stay in a booster seat.  If yes, then go to No. 4.
4. Can your child maintain the correct seating position for as long as you are in the car without slouching or moving positions causing the belt to move improperly to the neck or stomach?  If no, then your child should stay in a booster seat.  If yes, and you answered yes to all 4 questions, then your child is ready to use a seat belt without a booster seat.

4. When can my child sit in the front seat?

Children should not ride in the front seat until age 13. The safest place for a child in the car (or any person for that matter) is the back seat, particularly since the most common crash is a frontal crash.  Air bags deploy with such force that they can cause severe head and neck injuries to a child.

5. Do car seats and booster seats expire?

Yes, all car seats and booster seats expire. Usually they last about six years, but be sure to check for an expiration date on the seat label.

For more information:

• Car safety
• Is your child's car seat safe?
• FREE car seat checks
• Never leave your child alone in a car
• Look and lock
• Spot the tot
• From the car seat to the driver's seat
• Resources

About the author

Nicole Wineriter, M.D., is a Cook Children's pediatrician at the Heritage Trace Clinic. She is a Fellow with the American Academy of Pediatrics and a member of Safe Kids Tarrant County, led by Cook Children's, and a certified child passenger safety technician. 

The anger and subsequent anxiety I felt after hearing about “The Newborn Sleep Book” surprised me. I am not a “crunchy” pediatrician by any means. I have taught families to sleep. This is why the feeling I got in my stomach is unexpected.

The book is written by two pediatricians in New York who happen to be brothers, Lewis and Jonathan Jassey. The premise is that, through proper training, you can space a newborn’s feeds out to every 4 hours, resulting in them being able to sleep through the night. Their recommendations include: allowing them to cry until their scheduled feeding time, using Benadryl^® for sleep disruptions and increasing feeding volumes during the day to enable skipping nighttime feeds. It’s not the fact that they recommend sleep training; it’s their method that I find upsetting.

This goes against everything you are likely to hear from your pediatrician (certainly me), including the American Academy of Pediatrics. The AAP says some newborns feed as often as every 1.5 hours, while others about every 3 hours. The AAP also says breastfed newborns will feed 8-12 or more times per 24 hours once a mom’s milk has come in.

Oh and here’s something else important from the AAP: “If your baby isn't waking on his own during the first few weeks, wake him if 3-4 hours have passed since the last feeding.”

So that’s a group of 62,000 pediatricians’ recommendations who I tend to agree with on most things and two pediatricians who I couldn’t agree with less.  But I’m not finished making my case. Here are 8 myths I found particularly bothersome in the book:

1. MYTH: The authors have “continually researched and practiced (their) method, adjusted, and practiced some more.”

FACT: The best report of their results is this: a “ballpark estimate is that, since we started coaching parents …over 15 years ago, nine out of 10 parents who have followed through have been successful.” My scientific mind is not satisfied and neither should yours. I am not asking for a randomized, double-blind placebo trial, a simple survey would have been better than a “ballpark” estimate.Very few things in medicine have a 95 percent success rate. So, if you have the research, prove it … if not, it would not be that hard to get.

2. MYTH: Their method is the best way to get your child to sleep through the night.

FACT: The results I do see reported in the book are underwhelming. Their testimonials of patients who began to sleep through the night, included children with ages ranging from 6 weeks to 3 months.  A 2010 study in Pediatricsshowed that 37 of 75 babies were sleeping through the night during their third month. If you took testimonials of parents from that study (which are often the best case scenario), I would imagine you would find plenty of babies who would be sleeping through the night just as early as the Jassey families, many with no fancy plan.

3. MYTH: The authors are Ok with saying that their method may not work for everyone.

FACT: They go on to say later, “sleep training is by no means selfish on the part of the parents. In fact, since its benefits to both baby and family are undeniable, we might say that not sleep training…is a more selfish choice.” First of all, “undeniable?” Not so fast. That is still up for debate. I guess everyone has the right to make their own choices, even if they don’t mind making selfish choices, by not sleep training their children. It’s like saying; there really are no dumb questions, unless you ask a dumb question.

4. MYTH: Scheduling, even from a very early age poses no risk to babies.

FACT: Scheduling from birth as they suggest is dangerous and puts babies at risk, period. Not feeding on demand puts moms at risk for lactation failure. Their recommended 8-12 feedings (for 1-2 days) on demand is not enough for many moms to establish good milk supply. Ask any lactation consultant or pediatrician who understands milk production and they will either laugh or cry at the suggestion that scheduling this early will not affect milk production. In addition, infrequent feeding places babies at risk for increased weight loss and more severe jaundice, which requires further treatment and testing. If you are my patient, please do not schedule your baby from birth!

5. FACT: Crying babies are not all hungry (I actually agree with them, up to a  point …)

MYTH: You should never feed a baby before the time you have scheduled for them.

FACT: The authors state that our first response to a crying baby should not always be to feed them (again, I agree). However, I feel that we can go through our usual steps to comfort them (change diaper, pacifier (if a family chooses), rocking, etc.) and if they do not work, it is reasonable to attempt to feed.

6. MYTH: The authors state that they do not endorse formula feeding over breastfeeding.

FACT: Their method involves careful measuring of volume to ensure your baby gets enough each day don’t “have” to feed at night. Breast feeding simply does not work this way. A breastfeeding mom can’t simply feed a little bit longer… when the breasts are empty, they’re empty. So, while they may not endorse formula feeding, their method could push families toward formula feeding.

7. MYTH: If your baby’s sleep is disrupted for any reason (teething, vaccines, etc.), a combination of Tylenol^®, Benadryl^® and Motrin^® will help to “reset their clock.”

FACT: Uhhh, not for my patients. If your baby is fussy and you think it might be pain from teething, I am Ok with giving a dose of Tylenol or Motrin, but not along with Benadryl. The benefit is slim and the risk of an adverse event (whether appropriately or inappropriately dosed) is too high. Of course, they also mention using teething gels and you should know how I feel about them. There is no reason to treat a normal developmental stage with medicine.

8. MYTH: Feeding your child on their schedule means they will not “become hungry at inconvenient times-like 2 a.m.”

FACT: Parenting is about facing inconveniences. are ways to help your child fit into your life better than others, the very premise of this statement offends me. I’m sorry if your little baby woke up and tried to bother you at night for something to eat. I hope it wasn’t too much of an inconvenience.

The authors do address a concern in their book. It happens to be about co-sleeping, but that’s not important to them:

“We are inherently suspicious of any parenting technique that is so obviously weighted to the parents’ wants over the potential benefits to the child.”

Huh? Me too. This is why I would never recommend their book to my parents.

“When a child plays an electronic game and receives frequent intermittent rewards, their brains release dopamine – a neurotransmitter that is closely related to reward motivated behavior,” said Lisa Elliott, Ph.D., a licensed psychologist and manager of the Cook Children’s Behavioral Health Clinic in Denton. “In school or in other social situations, a child does not normally receive these rewards, making it more difficult for them to stay focused in a non-technology based situation.”

Elliott believes this is a factor contributing to the recent rise in ADHD. She said she is concerned about gadgets, especially video games, and what they could be doing to harm our children.  By allowing so much focus on technology and mobile devices, children aren’t learning to hold their attention without some type of reward.

Whatever the cause is, Elliott offers four simple ways to prevent the damage that gadgets could be causing your child:

1.Remove any screens from the bedroom.

2.Pay attention to the content your child is viewing, especially violence.

3.Set limits on screen time each day. The American Academy of Pediatrics recommends screens be kept out of kids' bedrooms and children should be limited to less than two hours per day of screen time. For children under 2 years of age, all screen media exposure is discouraged.

4.Create healthy playtime such as outdoors or being active.

These simple changes may make the difference in how your children perform this school year.And while your kids may be upset now, they'll thank you later.

About the source

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children's Behavioral Health, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. To make an appoinment with her, call 682-885-3917.

About the author

Caroline Gayler volunteers in the public relations department at Cook Children’s Health Care System. She is a senior at TCU majoring in Strategic Communications. 

These days many of the kids’ sporting associations, coaches, and sometimes even parents seem to be treating kids as little adults. However, kids are not just small grownups. Children are still growing, which makes them more prone to injury. They are also developing their strength, coordination and endurance as they grow. Kids participating in sports together, even though they may be the same age, vary in size as well as physical and psychosocial maturity.

Recently, there has been an increasing trend in younger children specializing in one sport. Specialization prior to adolescence can cause increased injury rates, early burn out on the sport and unwanted psychological stress for the athlete.

Counter to current trends, studies have shown that athletes at the elite level were more likely to start competing at a later age and compete in other sports until late adolescence. Research also supports that children who participate in a variety of activities and don’t specialize until reaching puberty are more likely to be more consistent in their performance.

Participating in a variety of sports helps with coordination, skill development, and gives the child a chance to rotate use of specific muscles to decrease the risk of overuse injuries.

It’s important for athletes, parents and coaches to be aware of the signs and symptoms of an overuse injury. These can include:

• Pain
• Swelling
• Changes in form
• Decline in performance
• Weight loss
• Anorexia
• Sleep disturbances.

Children also have the added risk of injuring their growth plates. What may cause a sprained ankle in an adult has the potential to fracture a growth plate in a child. These injuries have the possibility to disturb growth of the injured bone and cause deformity. A young athlete should never attempt to “push through” an injury. Too much stress on the bones or muscles can lead to tissue breakdown and further injury.

To prevent these injuries, the American Academy of Pediatrics (AAP) and American Academy of Orthopeadic Surgeons (AAOS) recommend: 

1. The athlete should be coached by properly trained people who are knowledgeable about proper form and technique.
2. Athletes should only participate at a level consistent with their abilities and interest levels.
3. It is important that the athlete is participating in activities they enjoy. The athlete’s desires should control their intensity of participation.
4. Athletes should not play one sport or type of sport (i.e. throwing) year round.

Young athletes should be followed by a health care team who can monitor the athlete’s body composition, cardiovascular system, sexual maturation and evidence of emotional stress. It’s recommended that children participating in high levels of activities have an ongoing nutritional assessment to look at total calories, balanced diet and intake of calcium and iron to ensure adequate intake for growth.

If at any time your young athlete is having pain or any of the symptoms above, please seek appropriate medical attention.

More resources from the Cook Children's Sports Performance Orthopedic Rehab Team Specialists (SPORTS):

• The basics of sports injury prevention for kids
• Rise of overuse injuries in school-age athletes 
• Top 10 questions parents have about sport injuries
• Young athlete’s injury prevention guide

About the author

Amanda Stukey, PT, DPT, is a physical therapist for the SPORTS program at Cook Children's. Our physicians, therapists, nurses and technologists work exclusively with kids and understand the unique needs of a growing athlete's bones, muscles, body and mind.

Get to know Justin Smith, M.D.

Justin Smith, M.D., is a pediatrician in Trophy Club  and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. Dr. Smith is an experienced keynote speaker for a variety of topics including pediatric/parenting topics, healthcare social media and physician leadership. If you are interested in having Dr. Smith present to your conference or meeting, please contact him at thedocsmitty@cookchildrens.org.

He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” open now. Click to learn more. To make an appointment, call 817-347-8100.

The American Academy of Pediatrics (AAP) released a statement recently encouraging pediatricians to talk with their families about the importance of daily, out-loud reading to your children (Literacy Promotion:  An Essential Component of Pediatric Primary Care Practice). Sometimes, when the AAP releases statements like this, that seem like common sense, I have to resist the urge to roll my eyes and tell myself, “Ok, thanks for stating the obvious.”

This one, while perhaps common sense, is very important. 

Why?

Despite the fact that I think most parents would agree with the importance of reading to your children, studies show that only about ½ of children are read to aloud every day.  In addition, reading to children sets the stage for their speech development which helps them do better in school. So what are the reasons for not reading to your child?

1. I don’t have time.

We aren’t asking that you read “War and Peace” every night with your 6 month old.  I’m hoping for about 5-10 minutes of reading (1-2 short books).  Ultimately, if you don’t have that much time then just read for the amount of time that you can, any amount is better than none.  Our kids really like to read during meal times as well, it tends to keep them eating and moving and keep their fighting about food to a minimum.  If you routinely watch TV during meals, it’s a much better alternative.

2. If they don’t understand, it doesn’t matter.

Reading to your children even before they are speaking is an important part of teaching them language.  Babies learn the sounds of language long before they know any words.  The number of words a child hears before they start kindergarten is a strong predictor of how well they will do in school. This is why it’s not only important to read to them, you should also spend time talking with them all throughout the day.

3. It is so boring.

This one I can really sympathize with. There are nights where I feel like I deserve an Oscar for my dramatic performances … but there are also nights where I drone on in monotone and doze off between pages. It is important to really engage your children as best you can, based upon their age. Have them help you count objects, letters or words on the page.  If it’s a book you’ve read 1000 times, read the wrong word and let them correct you (“Ohhhh … daaaadd, you’re so silly!”).  You can be selfish here.  Do whatever it takes to make it interesting for you, it will make it easier for you to do it and it’s likely that your child will enjoy it more as well.

4. They don’t even seem to enjoy it.

Let’s face it … sometimes they don’t even seem like they care. Your 12 month old is crying because he or she is tired but doesn’t want to go to bed. My 2 year old would rather chew on a book than have you read it.  My 5 year old would often rather be reading his own book than listening to me. But, I press on. Reading is not only beneficial for the language development, but studies show that it helps to develop more nurturing parent-child relationships.  Perhaps more importantly, is what it does for me. After a hard day at work, getting home to refereeing the boys fights for 2 hours, it’s nice to have some one-on-one time with each child to remember that I still like them.

5. No one ever told me it was important.

Well, you can’t use this one anymore can you?  Just in case you missed the message, it’s important.

Start by making a plan to read to your child every day for the next month.

Get a calendar out and mark off the days. 

I promise it will benefit your child for years to come.