Acknowledge All Feelings

• While children express stress in different ways than adults, they may still have many of the same feelings as adults. Sadness, worry, anger and feelings of loss may be common.
• Before moving to conversations about hope, ways to stay safe, and fun activities to pass the time, it is important to meet children right where they are emotionally.
• Validate your child’s emotions, “It is okay to be feel sad.” And let them know that you have felt that way too “I really miss seeing my friends, too.”
• Encourage expression of emotions in age appropriate ways. For example, art for younger children and journaling for older children.

Honesty is Best

• Even though you are doing your best to keep your child’s life feel as “normal” as possible, children can sense the changes going on around them, and they may have overheard adult conversations and news.
• Children also sense adult worry and anxiety.
• Children fear the unknown, and they often imagine things far worse than reality, so avoiding the discussion of Covid-19 with your children could cause more worry.
• To help your children to feel safe, explain Covid-19 in an honest, yet age appropriate way. See the resources below for age specific help.
• Begin by asking your children what they already know about Covid-19 or what they have heard, and build upon this knowledge. Your goal is to dispel misinformation and fears, not to cause more worry.
• For older children, use specific words children might have heard and ask if they understand the meaning (for example: social distancing, coronavirus, quarantine, pandemic)
• You don’t need to overwhelm children with information or great detail, but be willing to answer their questions openly, simply, and honestly.
• Follow your child’s lead. They will let you know when they have had enough information by asking to play or showing disinterest in the conversation.

Reassure Your Children

• Choose the right time to talk to your children. When you are feeling anxious or worried, this is not the best time. Take time to calm yourself before having important conversations with your children.
• Focus on what you are doing as a family to stay safe (washing hands, staying home, not attending social events, keeping distance from others while playing outside, and maintaining a clean home).
• Discuss how healthcare workers are doing their very best to take care of people who do get sick.
• Explain that most children are staying healthy, and most children have mild symptoms even if they get sick with this virus.

Keep Checking In

• As with any stressful topic, emotions and questions may change and develop over time.
• Revisit the conversation as things change, and be willing to discuss with your children when new questions arise.
• Watch children for signs of stress such as, lack of interest in typical play activities, trouble sleeping, or regression in development and contact your healthcare provider if needed.
• Reassure children that you will always be honest with them.
• Calm your children by explaining this will not last forever.

Routines Help

• Routines and predictability help children to feel safe.
• Keep old routines such as mealtimes and bedtimes.
• Create new routines and allow children to have control and choice in developing these routines.

Age Specific Resources

Preschool:

• Explaining Covid-19:
• Online book explaining social distancing

School Age:

• Printable book explaining Covid-19 (young school age)
• Video explaining Covid-19
• Comic explaining Covid-19

For other questions regarding COVID-19 and children, Cook Children's has developed a resource page with information for parents. 

Written by Cara Bozarth, a child life professional and clinical educator at Cook Children's.

Believe it or not, summer’s almost over and the new school year will begin before you know it.

Are you ready? Or are you like a certain dad I know who usually waits until the last minute? Last year, this dad forgot:

• To book his child's physicals so he had to scramble to get checkups before flu shots.
• His daughter has some pretty significant fears about going into school the first day and he didn’t take the time to properly prepare her.
• To get his son's asthma inhalers refilled and the forms on file so that he could have it at school (until April when he was having a flare).

Don't be like me…here are 10 steps you can take to make sure you and your child are ready for back to school.

1. Vaccines - Make sure that your child is up to date on vaccines. As your kids get older, your school might prevent them from enrolling in classes or other benefits, which might make it difficult to get their classes scheduled, etc. Vaccines are routinely scheduled at 4 years old (measles, whooping cough and polio among others), 11-12 (whooping cough and meningitis) and 16 (meningitis). At Cook Children's, we also recommend the HPV vaccination starting at age 11.
2. Physicals - If your child plans to participate in a sport or marching band they may need a sports physical form to be completed by your child's doctor. This requirement is required by the UIL before junior high, ninth and eleventh grade but many schools ask for it each year. The marching band requirement is new so not as many parents are aware. I expect we'll be doing a lot of those in the first few weeks of August. Students who are attending private schools or participating in sports that aren’t governed by the UIL may have other physical exam requirements. Many of these kids are already out in the heat working hard preparing for their upcoming season, so I recommend getting these as soon as possible.
3. Forms - Don't be that parent who realized in April that their child doesn't have his inhaler or the form required to take it at school (ahem ... me). Here are some common medications your child might take which might need to be administered at school: inhalers/nebulizers for asthma, insulin, ADHD medications and pain reducers.
4. Sleep - Transitioning back to a sleep schedule that works for school might be the most difficult transition in prepping for back to school. The older your child, the more likely they are to be going to bed too late and sleeping in. Start making subtle changes in their bedtime over the next few weeks. Rolling bedtime back 30 minutes at a time can make the transition to early morning easier.
5. Screen time - Just like sleep, screen time can get away from us a bit over the summer (Fortnite! I’m looking at you). An immediate drop off in daily screen time can be a struggle so starting to make changes now can help your screen junkies detox a bit before they go back to school.
6. Your child’s back to school fear or anxiety - Many children deal with some fears about going back to school. These fears can be mild or they can be more severe, almost debilitating. Helping your child prepare for the transition by talking them through their day, setting up a play date with classmates ahead of time or taking a tour of the school can orient (or re-orient them) back to school in a way that can be helpful. If the anxiety is more severe, consider talking with your pediatrician or a play therapist in advance to help them and you prepare.
7. Your back to school fear or anxiety - Getting yourself prepared for back to school is almost as important as preparing your child. Some parents will kick their kids out the door and drive off to their gym class without a second thought. For others, the transition can be just as hard on the parent as the child. Begin now to prepare yourself for what it will feel like those first few days at drop off. Showing emotions with your child is certainly OK, but a prolonged, tearful drop off can make things harder on your child.
8. Supplies - Get your child ready for back to school by buying their school supplies in advance whenever possible. Whether you buy the prepared packet from school or enjoy the process of shopping for individual supplies doesn't matter, just make sure your child is well prepared with what they need to start the year off right. Buy some extra tissues or hand sanitizer to help the teacher out.
9. Set goals - My favorite part of a new school year is the fresh start that kids can get. Whether last year was amazing or a huge struggle, it's a great opportunity to help our kids realize that they can always work on something to make themselves better. Using last year as a guide, help them set some goals that focus both on their strengths and challenges.
10. Attend meet the teacher night - Sometimes these events occur before school and sometimes they occur a little after school starts. Use meet the teacher night strategically to help frame your child in a positive light. This can go a long way to helping your child accomplish their goals for the year.

Whether you're counting the hours until you can send the kids back or dreading the return of early mornings, hopefully, these tips will help you think through some of the things you need to consider. I know it did for me.

What topics did we miss?

Related To This Topic:

• Vaccines and Immunizations
• Immunization Schedule
• Common Questions About Immunizations
• Knowing Your Child's Medical History
• Sleep Center
• Your Kids Are Ready For School. But Are You?
• 5 Questions Every Parent Should Ask Their Child's Teacher
• 6 Ways You Can Help The Teacher Understand Your Child

Should we plan on making baseball practice?

Are we prepared if the storm hits our home or while we are driving?

What can I do to ease the fears of my child who is afraid of storms?

First, your outdoor plans may need to be put on hold. According to the National Weather Service, you should start paying attention to the weather around 4 p.m. today. Storms will increase in coverage during the evening and overnight hours.

Next, have a plan for your family’s safety. Kaysey Pollan, Environmental Safety and Emergency Management officer at Cook Children’s, says everyone should know where they are going to go during severe weather.

“If you don’t have access to underground shelter, move to the interior room or hallway on the lowest floor and get under a sturdy piece of furniture,” Pollan says. “If you live in a mobile home, get out and find secure shelter.”

In addition to knowing where to seek shelter, families should have a designated meeting place away from home (a neighbor’s house or a street corner in the neighborhood) where you would gather if you were separated during an emergency. Make sure everyone in your family knows where the meeting place is located.

If you are driving during a storm, stay in your car and try to find shelter (but not under an overpass). The only exception is if there’s a tornado coming toward you. If you can’t find shelter, get out of the car and find the most low-lying area (ditch, ravine, etc.). Lay flat on your stomach and cover your head with your hands. If it’s hailing, stop driving and find a place to park like inside a garage, under a carwash or a service station awning. If you have small children with you, put them under you and cover their eyes.

Whether or not your child is afraid of storms, it’s important for parents to stay calm during severe weather. Children are quick to pick up on their parents’ fears and anxieties and during an emergency and they will look to you for safety and reassurance.

“Parents should do their best to manage their own anxiety. If parents are calm it will help calm their children,” said Kristi Mannon, Ph.D., psychologist at Cook Children’s Medical Center. “Parents should do their best to avoid watching news coverage in front of their children. Parents can check on weather updates on their phone or a device away from their children in order to stay informed.”

Dr. Mannon also advises parents not to dismiss their child’s feelings or to scold them.

“If a parent needs to complete a task such as preparing dinner and their child is expressing fear, they can take a break for a few seconds, make eye-contact with their child, acknowledge their fear, and tell them they will talk about it as soon as dinner is ready,” she said.

“You can help your child stay calm not only by managing your own fears, but by having a supply kit ready to go,” said Justin Smith, M.D., pediatrician at Cook Children’s Pediatrics Trophy Club. “Make sure you have snacks and something for your child to drink in case you have to remain under shelter for an extended period of time.”

Also, don’t let darkness become an added fear. Dr. Smith advises parents to have flashlights in a place that is easily accessible, and not just the one on your smartphone.

“You don’t want to run the risk of your phone dying and losing your flashlight too. It’s always a good idea to have a real flashlight handy,” he said.

Another tip – distraction can go a long way with children.

“Have a box of items that don’t rely on electricity such as coloring books, board games, a deck of cards or a favorite stuffed animal,” he said. “This can help during the storm and if you have to leave your house during a disaster.”

It is also important to be honest with children about what’s going on. However, make sure the amount of information and detail you share is appropriate for their age level.

It’s also a good idea to know the difference between a Watch and a Warning.

A Watch means conditions are favorable for severe weather to occur over the next several hours. The National Weather Service advises you to continue activities as normal, but monitor the weather and be ready to act if a Warning is issued.

A Warning means head for cover! This is an indication that severe weather is imminent or already occurring at your location. Seek shelter on the lowest floor of a sturdy building and stay away from windows.

One easy way to prepare for severe weather is to download the tornado app created by The American Red Cross. It provides alerts, watches, warnings, and plan-ahead lists right to your phone.

The American Academy of Pediatrics also has compiled a thorough list if wants to prepare for a disaster. You can find it here. 

About 3 percent of kids suffer from severe selective eating, to the extent that they can't eat out at a restaurant, said lead researcher Nancy Zucker, an eating disorders specialist at Duke University Medical Center in Durham, N.C.

Severely selective eaters are more than twice as likely to be diagnosed with depression or social anxiety, when compared with kids who'll eat anything, according to findings published online Aug. 3 in the journal Pediatrics.

Alaina Everett, a Cook Children’s licensed psychologist in Denton, says severe picky eating can be treated from a psychological/behavioral perspective as well as through oral-motor and sensory therapies and trying new foods for children who have severe selective eating can be terrifying.

“The fear is only intensified when parents make threats or express anger and frustration,” Everett said. “In our psychology department we emphasize the belief that kids do well if they can. Likewise they will eat well if they can. But there are obstacles that get in the way. Whether the original issue is a sensory processing disorder, oral-motor weakness or a gastrointestinal problem, all these kids have one thing in common, anxiety.”

From a psychological standpoint, these kids have had unpleasant experiences with food and the lingering trauma may be real. This is especially true for well-meaning moms who hide veggies in their kids’ favorite foods. If you have a seriously picky eater, Everett says this strategy will back-fire big time.

So how much anxiety can meal time actually cause?

“It is not uncommon in my practice to see children cry, scream, hide under the table, and quite literally shake at the sight of a novel food or when asked to join me at the table,” said Amanda Fyfe, a speech-language pathologist at Cook Children's in Arlington and Mansfield. “The anxiety severe picky eaters cope with is real and it can be intense. These kiddos often have months or years of negative food experiences fueling this fear, and unraveling it takes real work on everyone’s part. “

Fyfe says severely picky eaters:

• Have a significantly limited food repertoires (think 10 foods). These foods are probably similar in some way, although figuring out the rhyme or reason to what your little guy will or won’t eat can be mind boggling. It may be that his safe foods are the same color or have the same texture.
• Frustrate us with behavior that makes mealtime at home a catastrophe and eating out unheard of. He may refuse to eat with your family or cry and scream at the sight of the casserole you’ve so lovingly prepared.
• Refuse foods based on ALL sensory properties, including appearance, smell, texture, and taste. A picky eater may not even tolerate an offensive food on his plate. The sight of a non-preferred food may cause gagging, retching, and vomiting. Eating is more than simply chewing and swallowing. Interacting with, smelling, touching, and tasting are ALL important steps in the eating process. And disruption can occur at any step.
• May struggle to meet nutritional demands

“A child will not eat the broccoli and pork chops if you wait him out. He just won’t,” Fyfe said. “In fact, he may grow more and more rigid in his food selection because he IS hungry and grumpy. If a food or experience causes a child stress, discomfort, or pain, he will avoid it, plain and simple.”

Fyfe says these children are hypersensitive to foods in ways most of us might not even consider when planning our meals. Foods have to pass many tests before deemed acceptable for consumption, believe it or not, and severely picky eaters really put their meals to the test.

The first and possibly the most important test his dinner must pass? What it looks like. Children are acutely aware of the color of the food and may question why the color, shape, or size changes from bite to bite or from meal to meal. In addition, they might become overwhelmed by the smell of a particularly pungent food (think roasted broccoli, guys) and lose all ability to even consider tasting it. The texture of yogurt or pudding may cause a gag with incredible force. All of these reactions to food can lead to increased behavior disruption and meal time chaos.

“They can taste everything,” Everett said. “Zucchini pasta does not fool anyone and they are likely to stop eating pasta altogether. Presenting motivators like extra video game time can help, but it doesn’t solve the underlying anxiety. The scenario will just repeat itself when the next new food is presented.”

If your child shows signs of extreme picky eating, you will need some help. Talk to your child’s pediatrician about scheduling a feeding evaluation with a speech-language pathologist to determine the origin of the feeding woes and develop strategies to improve the eating experience for the entire family. A child psychologist may also be used if necessary.

http://www.npr.org/sections/health-shots/2015/08/03/428016725/could-your-childs-picky-eating-be-a-sign-of-depression

https://childhealthanddevelopment.files.wordpress.com/2012/03/kaytoomey.pdf

About the author

Amanda Fyfe is a speech-language pathologist at Cook Children's in Arlington and Mansfield. Speech/language pathologists focus on oral motor, speech, language and communication skills to enhance development, restore function and to prevent disability from pediatric conditions, illness or injury. Click here to find the closest Cook Children's Rehabilition Services near you.

I think in “Inside Out,” Riley’s family is always trying to be positive and give Riley joyful memories throughout her childhood. As the family moves and life starts to unfold negatively, we see other emotions; fear, anger, sadness and disgust, start creeping up in.

We see Joy work harder to keep Riley’s emotions as joyful as possible. Joy is an important part of our memories that we like to revisit. As a child life specialist at Cook Children’s, I try to help normalize the day and make joyful memories with patients and families.

These memories will help children cope with other struggles that they overcome and find joy in their life. As adults, we have a hard time with this because we have so many experiences with sadness, fear, anger and disgust it’s hard for us not to project our feeling on children especially when they are in the hospital.

Children that come into the hospital may experience different emotions, but joy can be found through these emotions, even when as adults we may think there is no joy.

Sometimes kids find so much joy that they don’t want to leave Cook Children’s because it has become a fun and not so scary place. We need to remember to look for joy with all that may go on in a hospital setting.

We might not think children do a great job at a procedure because maybe they cried. However, they may have held still and been able to recover with playing by the end of procedure. This can create a joyful memory with having families at the bedside showing comfort.

Sometimes going through these different periods of our life while growing up and experiencing many things good and bad allow our emotions to interact.

In “Inside Out,” we see that the character Joy realizes toward the end of the movie that you can mix your emotions and this can be considered normal. Joy realizes that you can cry tears of joy. So as a child life specialist we help families realize that tears in a difficult experience may help a child in the future to help to control his or her different emotions. The tears also allow us to look at our long-term memories and see how there might have been joy in that moment after all and change that core memory to be better than we thought.

This allows us to empower children with all these different emotions, especially joy, in their daily lives, in or out of the hospital. Joy is a great emotion which we all deserve to look for daily in our lives and others that live with us. What Joyful memory do you have?

Previous stories in our "Inside Out" series:

• Anger
• Disgust
• Sadness
• Fear

Heather Bayers is a Child Life specialist at Cook Children's. We know that a child’s illness or injury can impact a family physically, emotionally and financially. Fortunately, you don’t have to face these challenges alone. We provide a growing number of services for patients and families, all designed to help support, heal and encourage you through every step of your journey.

She is especially protective of Riley when looking out for her well-being. She’s on vegetable alert. Remember the peas and broccoli pizza? Disgust also acts as Riley’s social situation monitor, helping her make new friends.

So what really is the value in our children's everyday lives of feeling disgusted? To feel disgust, means we are offended by something, or have an extreme dislike.

When was the last time you said, “That’s disgusting!”? Was someone acting in a way you felt was inappropriate, or was there food on your plate that you truly didn’t want to eat? We can see disgust acted out in kids all the time.

Food sometimes just has to look like it doesn’t taste good, for them to turn up their noses and say, “yuck, not eating that!” Think about all the times you’ve tried to get your child to take medicine that they refuse, or spit back out at you. Those may not seem like the most positive examples, but they’re probably the most realistic. But, if disgust is protective, then it may also keep your child from eating something they shouldn’t, such as bugs, plants or medicine that’s not theirs.

Disgust in the role of acceptable social behaviors has the potential to be very important. If we teach our children there are certain values that are important, and morals to follow, they have the potential to be offended (disgusted) when behaviors opposite to their values are displayed. It may keep them from getting involved in substance abuse, risk taking actions and becoming sexually active. If disgust helps them to live up to the expectations they know are important, then it plays a very positive role with the voices inside their heads.

Disgusted behaviors aren’t always the most positive if you look at sarcasm, being snarky and generally thinking they know everything. We may laugh when we see children react to situations with some level of egocentrism, except maybe when they are our children and we think they’re being rude. So, lesson learned, how children (and adults) display their disgust is important. Just like anger, it’s OK to feel disgusted, but there may be certain behaviors that are unacceptable, such as throwing peas, when we are expressing our disgust. Providing examples of what is acceptable behavior when disgusted, such as using words, not actions, is definitely a teachable moment.

Disgust, in all her green-ness in Inside Out adds a certain level of humor that is probably better understood by adults because it’s subtle and mature. But, don’t we all want to have a little bit of her humor in our heads every day? I know I do.

Related 'Inside Out' topics:

• Sadness
• Fear

About the author

Jill Koss is director of Family Support Services and Child Life at Cook Children's. We know that a child’s illness or injury can impact a family physically, emotionally and financially. Fortunately, you don’t have to face these challenges alone. We provide a growing number of services for patients and families, all designed to help support, heal and encourage you through every step of your journey.

“Inside Out,” the new hit movie, helps us to understand, however, that sadness is just as important to our world and our perceptions, as joy and anger and all of the other emotions we encounter as human beings. We cannot pretend that sadness isn’t there. We cannot ignore it and hope it will go away. There is a reason for our sadness and if we don’t experience that feeling, it gets stuck inside where it grows and festers and can then prevent our other feelings from being realized.

We’ve heard the idea that we can’t know true joy without having known sorrow. The point in the movie where things change is when Riley’s parents stop and listen to her feelings. Riley tells her parents that she misses her old home and she wants to be with her old friends. Nobody is trying to change the way Riley feels. Nobody is trying, including Riley, to cover up her sadness with something else. Riley is allowing herself to feel the sadness and her parents are there with her, allowing her to feel. They are supporting her feelings and are listening to her.

As parents, we want our children to be happy. We want to protect them from pain. Unfortunately, that isn’t always possible. Once we understand that our children must go through pain and sadness, our job is to be there for them in those times.

We must allow those feelings to be experienced and we will likely experience the same feelings with them. Sometimes children (and adults too!) can’t put words to what they feel, but luckily words aren’t always necessary. As parents, we need to realize that at times silence is better. Don’t try to solve the pain. Don’t try to “make it better.”

As hard as it may be, let it happen.

As kids experience their feelings, they will begin to heal. Ask your child what they’re feeling and let them find their own way to tell you. They may not want to talk, so just be there. Hug them. Sit quietly with them and make sure they know you are willing to be by their side no matter what they are feeling. When they do talk about it, validate them. Tell them that it is okay to be sad, or angry, or confused. They need to know that whatever they are feeling is okay; it isn't wrong.

Here are a few examples of validating language that you can use:

“That sounds like it is really hard for you.”

“I can see that ___________ made you feel __________.” (Use their words for these blanks)

“I’m guessing you might have felt ______________ when _______________happened.” (When they aren’t providing you with answers of their own.)

Try to avoid these phrases/comments which invalidate someone:

“It’s not that big of a deal.”

“Don’t worry about it, you’re going to be fine!”

“You’ve got to be a big boy/girl, we’re not going to cry.”

Previous 'Inside Out' topics:

What 'Inside Out' teaches about fear

About the author

Shea Ingram is a music therapist at Cook Children's. At Cook Children's, music provides a creative intervention for children and young adults individually or in a small group format. It allows our young patients an outlet for the physical and emotional challenges they face in their lives.Music as an outlet and/or therapy aids communication and can be helpful to those who find it difficult to express themselves in words. Research supports music effectiveness in many areas such as: overall physical rehabilitation and facilitating movement, increasing people's motivation to become engaged in their treatment, providing emotional support for patients and their families, and providing an outlet for expression of feelings.

We can’t blame her, right? What parent doesn’t want joy to be the emotion that fills a child’s day, week, year and lifetime?

It’s the positive emotions, like joy, that we desire to be constantly filled with and to override the control center in our minds when any sign of the more ‘negative’ emotions, such as fear, sadness and anger start to rise.

Now, wanting to be a seemingly joyful, happy or content person is not at all a bad thing. Rather it’s that optimistic, glass half-full type of outlook on life that tends to attract others.

But what place do other negative emotions – like fear – have? Are they to simply be forever locked away in the subconscious realm of our minds? Could any expression of fear or anger or sadness, negative emotions that we so often seek to avoid, have a positive effect?

Fear is one of the emotions we hope our kids avoid. And when they inevitably do happen, we hope they overcome these emotions.

I believe that expressing our emotions, both positive and negative, can, in many cases create a more positive experience than suppressing or avoiding these more negative emotions such as fear.

Children who fear heights might not be the first in line to ride the rollercoaster. If someone fears snakes, they might bypass the reptile area at the zoo. When we fear something, we often try to avoid it. Sometimes, however, we inevitably are forced to come face-to-face with our fears. Or, we are placed in situations where we experience fears we didn’t know we had.

This happens all the time when children have to go to the hospital. For many children, going to see the doctor or coming to the hospital is a new experience. They often fear the unknown or their imaginations create a terrifying image of what is about to happen next. And when children have many hospital experiences and become ‘frequent flyers,’ they develop fears based on what they’ve experienced in the past.

Fears in this type of setting are almost inevitable. Our natural tendency as parents, adults or caregivers is to protect children from these fears by leaving out the scary details or distracting them so they won’t think about them.

However, many times these fears are still present and it is only a matter of time before they surface. So, rather than avoiding these fears to protect children from the hard or scary things, why not help children to process these fears and work through them?

Rather than telling children who might be scared that “there is nothing to be afraid of,” why not talk to children about what they are worried about? We can begin to work through these fears with them, developing strategies for facing fears that they might inevitably encounter, and empower them to overcome.

They may learn that just like in ‘Inside Out,’ fear is not so bad and sometimes needed.

About the author

Cristin D. Herbort is a Child Life Specialist at Cook Children's. Our Child Life specialists work with kids and families to make their visit to the medical center easier and more comfortable. Child Life staff members recognize that hospitalized children still need opportunities to just be kids. They help children and families cope with a hospital experience by providing emotional and developmental support, giving honest information geared to the child's level of understanding and providing fun activities.