Protect those noggins

As the weather FINALLY begins to improve, and as I have begun having more opportunities to get outside and play with our 3-year-old son, I am reminded about how important it is have a helmet for your child.  My son is only tooling around on a tricycle, but I think it is still important to instill this practice early.  Approximately 33 million children ride bicycles for nearly 10 billion hours each year. Unfortunately, bicycle crashes and bicycle-related head injuries cause 150,000 emergency department visits and nearly 400 deaths each year.

Your child should to wear a helmet on every bike ride, no matter how short or how close to home. Many injuries happen in driveways, on sidewalks, and on bike paths, not just on streets. And remember, children learn best by observing you, so make sure you set the example: Whenever you ride, put on your helmet. Every time I put my helmet on, I think about my sister who just a couple of years ago was mountain biking on a path, lost control, flipped off of her bike and went head first into a tree.  Her helmet cracked in half, but she walked away (a little shaken up, but without any serious injuries).  I hate to think about how that scenario would have played out if she was not wearing that helmet.

If you have not worn a helmet in a while, or have not bought one for your child before and are wondering how it should fit, you’re in luck! It should fit as follows: It should be worn so that it is level on the head and covers the forehead, not tipped forward or backwards. The strap should be securely fastened with about 2 fingers able to fit between chin and strap. The helmet should be snug on the head, but not overly tight. Skin should move with the helmet when moved side to side. If it does not seem to fit initially, the helmet’s sizing pads can help improve the fit.

Riding a bike is a great way to stay active this summer.  Just make sure that you and your family are protecting your noggins!

Children and Grief

My best friend’s husband died unexpectedly at the age of 43 last week, leaving my friend to raise their 10 year old daughter alone. We have been friends since high school, and she still lives in Michigan. I road tripped with my two daughters to spend some time and lend my support this weekend. Death is hard for most people to deal with, let alone trying to explain the unexplainable to a child. My friend described how her heart broke having to tell her daughter about her Daddy’s death. So what is the right way to deal with children and grief? I do not think there is a right way. You have to speak to the child at their developmental level, and allow them to grieve as they need to. My friend told her daughter with the support of all the immediate family around her, and had her in grief counseling within days of the event. She shielded her from the parts of the wake and funeral she felt she couldn’t handle, but allowed her to say goodbye in a way that she could. What did we do? I brought toys and my daughters to cheer her up, and took her to a bounce house to get her mind off of what had happened. I am not saying that will fix her problems, but taking her mind off of what is going on even for a few minutes and letting her be a normal kid can only help. I got her a grief art kit that helps kids express their feeling through art when she feels up to it. Most importantly, hopefully we reinforced to her and my friend that she is loved and supported. One of the things that is helping her get through this is that her Dad would send her text messages every day. They were funny stories to the simple “I love you,”, and they are now her most cherished memories of her father. Think about it, have you taken the time to hug your child and tell them you love them? How many times are we too busy with our everyday life to stop and spend that extra minute being with them and enjoying them? I hope I learned from this experience to take that extra moment, because life can definitely be too short. Give your kids a kiss and a hug today from me!

I love to read

I love to read and I have always loved it. I was one of those kids that stayed up all night reading. If I was one of my patients I would comment on how great it is to read, but it is also important to get a good night sleep and to put the book down to get some exercise.
When my children were first-born, I couldn’t wait to share my love of reading with them. From Goodnight Moon to Blue Hat, Green Hat to Amelia Bedilia I loved to read to my kids. Then they started to read and it became even better, we would lie in bed at night and they would read a page and then I would read a page. Even reading the same book over and over was never boring, because every time giggles would come out, especially from my youngest one Danya.

Research has shown how important reading is for brain and language development. Study after study shows the impact of early reading to our children and how this will help them succeed in school. While this is definitely important, I feel even stronger about the bond that reading brings to the relationship I have with my children.

I thought as they got older I would miss the days of reading to them. While I am nostalgic about those days, I treasure that now I get to read with them. I loved when my oldest Hannah read the Harry Potter series I read each and everyone along with her and loved that she remembered even more details about each book then I do- and she still does to this day. When my youngest read the Hunger Games series and then the Divergent series- the other two kids and I read them along with her. It made for great conversations,including which faction each person in our family would be in if we lived in the Divergent world. (If you want to know which one they put me in ask next time you see me in the office). My son Avi didn’t enjoy reading as much as the girls. He would do it for school, and we did find some things he enjoyed such as any Dan Guttman book or Mike Lupia story. He even read the Hunger Games and Divergent series when the rest of us did. (He did try to get my husband to read them but he prefers non-fiction). But this past month he had a read a book for his history class. When he told me what book it was, I remember thinking - oh no, he is never going to enjoy that. It is a “mom’s book” or a “book club book”. Well, I was wrong. He read A Thousand Splendid Suns  by Khaled Hossein and he really enjoyed it. This is the next book I will read.

It is great now that my children can recommend books to me. I really enjoyed reading the Hunger Games and Divergent series this year. I know not great literature but they are fun and they get kids to read. Also this year I read two great books that my almost 12-year-old read. One was Wonder by RJ Palacio and the other Out of My Mind by Sharon Draper. Both books were about kids with different types of disabilities and how they respond to the world around them, but more importantly how the world around them responds to them. These are setting up great conversations and have amazing teaching points for both kids and parents.

So next time your child picks up a book, ask what they are reading and try reading it you just might enjoy it.  Also, please feel free to share some of your favorite books here -I am always looking for the next book to read!

Presentation for parents: Attention deficit hyperactivity disorder

Part of what we do is help parents be parents by providing resources.   One of the many resources we would like to share is the North Shore Center.  The North Shore Center has started providing presentations for parents.  Unfortunatly, this is very quick notice.  Look for more presentations in the future.  We will post these in a more timely manner for future presentations.

Presentation for Parents

Attention Deficit Hyperactivity Disorder: What is it Really, Does my Child have it and when is Medication Needed?

March 12 7:00 PM-8:15 PM

March 14 9:15 AM-10:30 AM

At North Shore Center:

10303 N Port Washington Rd.

Suite #201 (Up the Stairs)

Mequon, WI 53092

With increasing media attention, more parents and adults are wondering if they and/or their children have ADHD. Psychologist Dr. Michael Mazius and Nurse Practitioner Nina Sebastian will address the common signs and symptoms of ADHD, how to distinguish ADHD from other mental health and educational conditions and when to consider adding medication to the treatment plan.

Information on the Presenters:

Dr. Michael Mazius is a Ph.D. psychologist and director of North Shore Center. Dr. Mazius specializes in the treatment of children with Attention Deficit Disorder, academic  underachievement syndrome, and other learning, emotional and behavioral problems.

Nina Sebastian is a Nurse Practitioner specializing in providing psychiatric evaluation and medication management for children, adolescents, and young adults with behavioral health concerns.

Nature’s cough medicine

There are no good cough medicines. The drug in most cough medicines, dextromethorphan, has never been shown to be effective in treating cough in children. If you are like me, you already knew that from sleepless nights spent coughing as a child after your mom gave you Triaminic. There has been some interesting research lately on an all natural substance in the treatment of cough, honey.  In fact if you have looked on the shelves lately there are some companies selling homeopathic cough medicines that are mostly honey but you can also use the stuff from the honey bear you have in your cupboard.

The next time your child has a cold with a cough give it a try, as long as they are over 12 months old. Honey is not safe for children under 12 months because of the potential for botulism exposure. Give one-half to one teaspoon to children aged 1-5, one teaspoon for kids 6-11 and 2 teaspoons for children 12 and older. Hopefully it will help everyone in the house get some more sleep.

Potty Time! Excellent!

My household has recently been in a long-standing battle of wills. It is not a rare occurrence to see and hear my son yelling and crying at me one minute, followed by cheering, smiling, and high-fiving me the next. Most parents of toddlers will know what I mean when I say, “Man, I am ready for potty training to be done.” Up to this point, I would say, without a doubt, that toilet training has been one of the most frustrating times for me as a parent. It also can be one of the most difficult developmental phases that both children and parents experience together because pressures for the child to conform to parental and social expectations occur at the same time with a child’s growing need for independence. Because of this, we as pediatricians recommend that parents avoid pushing their child into toilet training, and suggest instead that the process begin only when the child is developmentally ready or shows signs of readiness. Trust me, this can save hours of frustration for everyone in the family, and sometimes a day or two (or even a month or two) of “taking a break” from toilet training can be enough time for a switch to flip in your child and have him/her make great strides.

Learning independent toileting is a gradual process that is driven by the child’s motivation and interest.  Initially, the parents should explain what needs to be done, perhaps by demonstration (I know, kinda weird), but then it is the child’s willingness that will determine when to attempt the next steps. Remember that during this process the child’s self esteem is delicate. The parents should encourage, reinforce, and praise the child for each accomplishment of toilet training. Positive reinforcement should always be used.  As difficult as it may seem, negative reinforcement like yelling, belittling, and taking things away from your child for having an accident should never be used. In my house, we have over-the-top celebrations after the deed is done, followed by a race to the sticker chart. Our son gets one sticker for “number 1” and two stickers for “number 2.” Ten stickers equal a small prize. This is the plan that has had the most success with our son up to this point, but it may not be the best for your toddler, so I encourage you to try different things and find something that works best for him/her.

There are three variant forces in child development that need to be in place in order for toilet training to progress: physiologic maturation (eg, ability to sit, walk, dress and undress); external feedback (ie, understands and responds to instruction); and internal feedback (eg, self-esteem and motivation, desire to imitate and identify with mentors, self-determination and independence). More specifically (because most of us out there are not sure when these things occur), at about 18 months, children may show signs of readiness; at 24 months, a step-by-step approach for teaching the child his/her role in the process should be initiated; at 30 to 36 months, most children will have achieved daytime continence; and finally, at 36 to 48 months, most children will have completed nighttime training. That being said, these ages are not set in stone. Every child is different, and even the sex of the child can be a factor in when the child is potty trained (ON AVERAGE, girls usually are potty trained by about 36 months of age, and boys, usually a little later, by about 38 months of age (add your own “typical guy” comment here)). Remember, these ages are averages, so there is a very wide range.

Another thing to remember, which can be very hard to do, is to not compare your child’s success or failure with his/her siblings or other children his/her age. This may push your child in to toilet training sooner than he/she is ready and could add unnecessary stress and strain (pun intended).  Some parents might wrongfully equate toilet training success with intelligence or attribute the child’s lack of interest in toilet training to the child’s character (ie, the child may be perceived as stubborn, lazy, uncooperative, hostile, or perhaps jealous of a new sibling). When parent–child relationships are strained, both parent and child may need a break from toilet training to focus on enjoyable activities together and establish a stronger mutual trust and cooperation.

Okay, so you think your child is ready to potty train, but how the heck do you get the whole process started? First, get a potty chair. Many kids feel more secure on potty chair than a toilet because their feet are securely on the ground, and they are not afraid of falling off. Have your child get comfortable with the chair by observing it, touching it and sitting on it fully clothed.  Never force them to sit on it, and let them leave the potty chair when they want. Tell them that it is “your special chair.”  Place the chair in a convenient place where your child can get to it when he/she wants (the playroom, outside during the summer, wherever the child is playing). It does not necessarily need to stay in the bathroom. Once your child is comfortable sitting on the chair fully clothed, have them sit there without clothes.  You can also try putting stool from a diaper into the potty chair so your child can see where it should go. It also can help if you sit on a toilet and “demonstrate” for your child.

Setbacks during the toilet learning process (eg, the child starts to withhold stools or insists on wearing diapers after learning to use the toilet) tend to occur or escalate if the child is pushed too hard or too fast, or if a significant, stressful family event (eg, new sibling, new home, or new child care provider) transpires. Regression is a normal part of the toilet training process, does not constitute failure, and should be viewed as a temporary step back to a more comfortable place. During toilet training, children can be very sensitive (both psychologically and physically), and even one episode of having a hard or painful bowel movement can lead to withholding (which can lead to a downward spiral of harder, more painful stools, which leads to more withholding) Withholding behavior often can be improved by an adequate intake of dietary fiber (fiber content = child’s age + 5 g per day) and decreasing excessive milk intake. Sometimes, however, it may necessitate adding a stool softener. Certain elements of toilet learning can prompt fears, such as flushing or the disappearance of feces or urine, and may even discourage further development in toileting. Allowing the child to flush a piece of toilet paper or joining the child in saying “bye-bye” to excrement may alleviate some of the anxiety a child might feel as it disappears. Another setback can occur when the child is with different caregivers throughout the day, and expectations are different with each person. Make sure to coordinate your toilet training plans with others who may be with your child during the day (caregivers, grandparents, day care staff members). It is important that they know how you want your child to be trained so that the child receives the same message during the day when you are not present as during evenings and weekends when you are.

I know that potty training can be a long and frustrating process, but stay positive and consistent. It will happen, and when it does, the rewards will be great. Good luck!