By: Leanne Bensko, MD

“Is it ok for my child to participate in resistance training?” 

We often get asked this question or more specifically in what types of activities should my child participate?  Most families know that aerobic exercise is helpful in maintaining a healthy lifestyle, but many parents do not realize the importance of resistance training at a young age in promoting physical fitness and physical literacy (moving with confidence and competence). 

What is resistance training?  Contrary to many beliefs, it is not just lifting heavy weights.  Resistance training includes bodyweight exercises, use of kettle bells, free weights, barbells, elastic bands, weight machines and medicine balls to improve overall muscular strength.   

For years it was thought that if children participated in resistance training it would have a negative effect on linear growth, increase their risk of injury and could lead to unwanted muscle hypertrophy.  This has since been proven to be false.  In fact, injury rates with supervised resistance training by a qualified professional are lower than those occurring in other sports or general recess play.  Furthermore, strength gains prior to puberty primarily arise from increased motor neuron recruitment rather than muscle hypertrophy. 

Today’s youth are weaker than previous generations and most children do not get the recommended 60 minutes of moderate to vigorous physical activity a day.  Many studies have shown that there is a steady decline in “muscular fitness” of children due to their increasingly sedentary lifestyle.  Muscular fitness refers to one’s overall muscular strength, endurance, and power.  Higher levels of muscular fitness have been found to be one of the best predictors of moderate to vigorous physical activity in 5- to 10-year-olds and these youth are more prepared to sustain participation in this type of physical activity across their lifespan.  This reiterates the importance of resistance training for all youth, not just those who participate in sports.   Resistance training has also been shown to have a positive impact on bone health, cardiac health, metabolic health (decrease insulin resistance), and mental health. 

The American Academy of Pediatrics (AAP) updated their guidance on resistance training for children and adolescents in June 2020.  In this statement, the AAP recommends resistance training for children as young as 5 years of age.  Many 5–7-year-old are already involved in sports and could benefit from developmentally appropriate strength building.  At this age, strength building is through body weight exercises, such as the “animal exercises”. These include frog jumps, crab walks, kangaroo hops and one leg hops.  Great options for children at this age include gymnastics, tumbling and rock climbing).  Here, kids will build strength through bodyweight and core exercises while having fun with their peers.  As children get older, appropriate exercises are based on what the AAP describes as a child’s Resistance Training Age, or the amount of time a child has spent in formal resistance training, and the child’s Resistance Training Skills Competency (RTSC).  This is where it is important to have a qualified professional evaluate and supervise your child to decrease the risk of injury and increase their potential for muscular gains.  Many physical education teachers are now offering strength classes as an option for PE and more and more community centers have strength building classes geared towards youth.  A certified personal trainer is also an option but can be cost prohibitive.  Many of these training facilities are now offering classes geared towards children because they understand the importance of learning the basics of resistance training at a young age. 

 We encourage you to consider incorporating resistance training into your child's routine. It's not only permissible but highly beneficial when done appropriately. By nurturing your child's physical development through structured exercise, you are laying the groundwork for a lifetime of health and well-being.   

Please remember to reach out to us regarding whether or not it would be medically appropriate for your child to participate in resistance training/strength training due to a particular medical condition. 

As the leaves begin to change colors and the air becomes crisp, the fall season provides a perfect backdrop for outdoor adventures and creative playtime with kids. While pumpkin picking and apple orchards are always popular choices, there are many more exciting activities to engage children during this wonderful time of year. In this blog post, we will explore a range of fall activities that are not only fun but also beneficial for children's physical and mental development. Let's dive into the world of fall fun and make the most of this beautiful season!

Nature Scavenger Hunts

Fall offers a unique opportunity to explore the wonders of nature. Organize a nature scavenger hunt in a local park or your own backyard. Create a list of items for kids to find, such as colorful leaves, acorns, pinecones, or specific types of trees. This activity not only encourages children to be observant but also fosters an appreciation for the environment.

Leaf Art and Crafts

Gather fallen leaves of various shapes and sizes, and let the kids express their creativity by making leaf art and crafts. They can create leaf animals, leaf collages, or even use the leaves as stencils for painting. This artistic endeavor can help improve fine motor skills and unleash their imaginative side.

Pumpkin Decorating

Pumpkin decorating is a classic fall activity for children. Let them choose their favorite pumpkins, and then provide paints, markers, and other craft supplies to turn these orange gourds into masterpieces. This hands-on experience enhances hand-eye coordination and artistic skills while celebrating the spirit of the season.

Scarecrow Building

Get kids involved in creating their very own scarecrow for your garden or porch. This collaborative project teaches teamwork, problem-solving, and encourages outdoor play. Gather old clothes, straw, and other supplies and let the kids design their scarecrow, complete with a personality all its own.

Nature Science Experiments

Engage kids in interactive, nature-inspired science experiments that teach them about the changing season. For instance, collect a few leaves and explain the concept of photosynthesis. Observe the leaves over time to see how they change in color. This educational approach to play encourages a love for learning.

Apple Bobbing and Tasting

Take a trip to a local apple orchard and allow kids to pick their own apples. Afterward, host an apple bobbing session or an apple tasting party. Discuss the different varieties of apples and their unique flavors. It's a delightful way to teach kids about healthy eating habits while having fun.

Fall is a season of transformation and beauty, and it offers countless opportunities for kids to engage in enriching and fun activities. These fall-themed activities not only stimulate creativity and physical development but also encourage children to appreciate the natural world around them. As pediatricians, we understand the importance of play in a child's development, and we hope these ideas inspire you to make the most of this wonderful season. Encourage your kids to get outside, explore, and learn while having a blast in the process. Happy fall, and happy playing!

Written by Tyler Calway, MD

Summer is here and it's a great time for children to enjoy the outdoors, but it's important to keep them safe while they do so. With the sun shining and temperatures soaring, there are several precautions parents can take to protect their children during the summer months. Here are some important safety tips to keep in mind—and see if you can find a little easter egg for your entertainment!

Helmets

Bicycling, skateboarding, and rollerblading are popular activities among children during summer. Wearing a properly fitting helmet can help prevent head injuries and is the most important safety equipment for these activities. Parents should ensure that their child wears a helmet every time they ride and that it is securely fastened under the chin.

Swimming Safety

Water activities such as swimming and playing in the pool are common during summer. Children should always be supervised by an adult when near water, even if they know how to swim. Parents should also ensure that the pool area is secured with a fence or other safety barriers to prevent unsupervised access. In addition, it is important to teach children basic swimming skills and to be cautious of shallow water, as diving headfirst can lead to serious injuries.

Protection from the sun's harmful rays is essential during the summer months. Sunburns can be painful and can increase the risk of skin cancer later in life. Parents should apply sunscreen with at least SPF 30 (preferably mineral based such as titanium dioxide) to their child's exposed skin every two hours while outside. It's also important to remember to reapply sunscreen after swimming or sweating.

Heat Safety

Summer temperatures can be intense, and children can be at risk for heat exhaustion or heat stroke if they don't take precautions. Parents should encourage their children to stay hydrated by drinking plenty of water and avoiding sugary or caffeinated drinks. They should also avoid outdoor activities during the hottest part of the day and ensure that children wear light, loose-fitting clothing.

Insect Protection

Insects like mosquitoes, ticks, and bees can be a nuisance during summer and can also pose health risks. Parents should dress their children in long-sleeved shirts and pants when spending time outdoors and apply insect repellent that contains DEET. They should also check their children for ticks after spending time in wooded areas.

Fireworks Safety

Fireworks are a popular activity during summer, but they can be dangerous if not used properly. Children should never be allowed to handle fireworks, and adults should always follow the instructions on the packaging carefully. Fireworks should only be used in open areas away from homes and other structures, and a bucket of water or hose should be nearby in case of an emergency.

Summer can be a fun and exciting time for children, but it's important to keep them safe while they enjoy the outdoors. By following these safety tips, parents can help ensure that their children have a happy and healthy summer!

Written by Tyler Calway, MD

Spring is finally here and we're excited to announce the launch of our brand new website! Our team has been hard at work to create a website that is both informative and user-friendly for parents and families. We're thrilled to offer a variety of exciting features that will make it easy for you to connect with us and get the care you need for your child.

As the spring and summer begin to get busier, make sure you schedule your child’s annual well-child visits. Follow us on Facebook, Instagram, and TikTok for the latest news and updates about our practice. We'll be sharing helpful resources, articles, and tips on how to keep your child healthy and happy. Plus, we'll be hosting Q&A sessions on our where you can ask us any questions you may have about pediatric care.

Our website also features a blog where you can find articles written by our pediatricians on a variety of topics related to child health. From sleep training to nutrition to mental health, our blog covers it all. We'll be updating our blog regularly, so be sure to check back often for new content. Please check out our blog archive to see blog posts from yesteryear.

In addition to our online resources, we're also proud to continue offering in-person walk-in appointments at our clinic. We know that visiting the doctor can be stressful for kids, so we've designed our clinic to be a welcoming and comforting environment for children of all ages. Our pediatricians are experienced in working with kids and will do everything they can to make your child feel at ease during their appointment.

As a reminder, we offer a wide range of pediatric services, including well-child checkups, sick visits, immunizations, and more. We also offer specialized services such as behavioral health consultations and lactation support for new moms. Whatever your child's healthcare needs may be, we're here to help.

We hope that our new website will make it easier for you to connect with us and get the care your child needs. Whether you're a new parent looking for a pediatrician or an existing patient, we welcome you to explore our website and learn more about our practice. We look forward to serving you and your family!

Acting classes for parents: acting up, acting out and learning to read cues

A summary of a behavior and discipline Q and A conversation with Drs Scott Goldstein and Rebecca Unger in the Family Matters Parenting Discussion Series

Q:  What do I do if my toddler often “goes crazy”?

A:  It is common for toddlers to lose their mind. It is good for them to be curious. It is typical for a toddler to have mood swings, test limits, have minimal impulse control and believe that the world centers around him. Show your toddler a more helpful alternative. Ignore the undesired behavior and let him know that that you will pay attention to him once she calms down.

Other tips for toddlers:

• Offer reassurance and encouragement for positive behaviors.

• Set reasonable limits.

• Be consistent, although recognize that each parent/caregiver does not have to have the same discipline style.

• As much as possible, remove unsafe temptations in the path of your toddler.

Q:  How do I handle temper tantrums in general, and what do I do if my toddler has a temper tantrum when I am out and about?

A:  Temper tantrums are excellent learning devices. Tantrums help your child learn that she can calm herself down (rather than kick and scream) to get your attention. It is helpful to tell your child that while she is having a temper tantrum (because you love her so much and you want to help her learn to calm herself down) you will ignore her, but after she calms down, you will give her a big hug.  Positive physical contact after the temper tantrum can be very helpful. It is helpful to have this communication during a calm moment, rather than in the middle of a tantrum moment.

If the temper tantrum is in a public place and your child is not calming herself down:

1. Gently explain to your child that you will leave the location.

2. Calmly leave with your child and ignore her screaming and undesirable behavior as much as possible. This is not easy, but do your best!

3. Remember the other families at the playground, museum or grocery store have been there and done that too!

Other temper tantrum tips:

• Offer physical reassuring contact after the temper tantrum is over.

• Do not dwell on the behavior after the tantrum. There is no need to discuss and dissect what just happened. That brings more attention to the undesired behavior.

Q:  When my child is hungry or tired and I can see that she is on the path towards being naughty, what should I do?

A:  Ignore and distract!! Encourage your family to engage in regular and healthy routines around mealtime and sleep time.  Limit screen time, especially during mealtime and bedtime. Try to minimize rushing during transitions as much as possible (pick out school clothes/pack a lunch the night before, get breakfast partly ready ahead of time, wake up a bit earlier).

Q:  What do I do about afterschool meltdowns?

A:  After a long at school, it makes sense that your child might be uncommunicative and somewhat cranky.  Consider providing an afterschool snack on the way home from school. Try to avoid asking “How was your day?” or “How was school today?”. Instead of the dreaded, “How was your day” question, try something like, “Tell me about the best (or worst) part of your day. Did any of your classmates do something funny today? What did you read/learn about today? Did you ask any interesting questions?

Q: What do I do if my child will not sit at the dinner table?
A:  Family meals are one of the most important priorities to help your child survive and thrive. Family meals even reduce teenage risk-taking behaviors. There is a lot to learn around a screen free dinner table (unless it is the World Series!).  Believe it or not, this could start as early as when your 6-month-old baby is eating more and more table food. 

If your child if not being helpful at the family meal table (throwing food, getting up and down) try these steps:
1. Ask him to stop the undesired behavior. Maybe give him a second chance after your warning. 
2. If things persist, gently ask him to leave the table.   Explain that his behavior is unacceptable in your home.  
3.  Help remove him from your family meal. Ignore him while the remaining family members continue enjoying the meal.  Exaggerate that enjoyment by throwing confetti, lighting candles, telling jokes, etc. It is likely your ostracized child will not make that same decision twice, or certainly not three times.   Do not worry about the nutritional status of your child!  He will not go to bed hungry if you give him a hearty bedtime snack.  He does not have to know the hearty snack was given because he did not eat dinner.  This is another tool in his ‘coping tool box’ to help him all along the way.  

Q: What about sticker and star charts?
A:  Let’s call this behavior modification rather than bribery.   For some children this could be very motivating.   Help your child create her own chart.  You could help her draw a simple board game (like Candyland!) with 5-10 squares, or whatever you think is best. Once she reaches the finish line, a simple family reward goes a long way. 

Other important tips

• It is important to admit when you are wrong and to apologize. This is an important behavior to role model for your children.

• Be specific with your praise. This helps your child know what to expect.

• Celebrate good times. Your family is a laboratory for learning for your children. Play games, go for walks, listen in and engage in supportive conversation.

October is National Bullying Prevention Month, an international campaign to raise awareness of bullying prevention. The Internet can be a daunting place for children and can be a source of bullying. This is why it is so important for families, parents and children of all ages to have the toolset to tackle the intricacies of the Internet. 

The American Academy of Pediatrics policy statement about Media and Young Minds reports that children between 0-5 years of age are undergoing critical brain development, building secure relationships, and establishing health behaviors. Attention to social interaction and hands on learning is critical for healthy development. Limiting family media use from the beginning can optimize this development.

Children as young as 15 months old can learn from touch screens, but it’s hard for them to apply that to their 3-dimensional world. Video chatting with responsive adults can help children learn and connect with others, however there is a need for ongoing parental support to help young children understand their experience. 

Preschool children can benefit from well-designed media programming, however for most of the thousands of apps that claim to be “educational” there are no established criteria to confirm the benefit.  It is optimal to teach young children executive functioning, task persistence, impulse control, and creative thinking through unstructured and social play rather than digital learning.  

It is also important for parents to monitor and engage in media usage with older children. Parents can use these opportunities to explore educational aspects of the Internet, as well as learn from their children. The learning goes both ways! It is important for parents to speak to their children about “online citizenship” and safety, which includes treating others the same way offline as they would online. When children are engaged in these conversations they can learn to avoid compromising communications and cyber bullying, as well as learn to whom they can turn to when they encounter challenges. 

Families can mutually learn about the importance of creating screen free zones, develop an understanding of how to use technology in social ways, as well as focus on healthy sleep, nutrition, and physical activity patterns despite the temptation of media.

Understanding the recommendations, and establishing family rules and guidelines, helps create safe boundaries. These boundaries can be a springboard for children to explore and feel supported. 

Recommendations for family media use:

1. Start this conversation early. Parents should examine their own media use and avoid digital media use (except video chatting) in children younger than 18-24 months of age.

2. Understand brain development in young children and the importance of hands-on, unstructured, and social play to build healthy social skills and habits.

3. For children 18-24 months choose high quality programming when/if you introduce digital media. Co-view all programs with your young child.

4. For children 2-5 years, limit screen use to 1 hour/day of high quality programming. Help children apply what learn to the world around them

5. For children 6 and older place consistent limits on time spent using media, types of media, and assure that media does not interfere with healthy sleep, physical activity, and other healthy behaviors. 

6. Designate media-free times together, such as dinner, driving, and before bed. 

7. Have ongoing conversation about online citizenship and safety – including treating others with respect, online and offline. 

8. Develop a Family Media Use Plan for children of all ages.  The American Academy of Pediatrics has information including the recommendations and a template that helps start this conversation at 

Adapted from AAP recommendations, 

Cyber bullying awareness:

Even though the Internet has many positive benefits, it does come with its own dangers. For serious parenting issues, cyber bullying is a relatively new concern that has developed in the past several decades. The problem with cyber bullying is the potential anonymity, the pervasiveness, and the possibility for things to get out of hand far quicker than in person. Some warning signs that cyber bullying is affecting your child are changes in their technology usage (including texting), their emotions (especially in relation to their technology usage), and withdrawal from activities that/people who they used to enjoy. If you think that your child is being cyber bullied, here’s what you can do:

1. Notice. Recognize a change and try to see if those changes happen around their use of their digital devices.

2. Talk. Ask questions to learn what is happening and who is involved.

3. Document. Taking screenshots can help if law enforcement needs to be involved.

4. Report. Most social media platforms and schools have clear no bullying policies and they can take the proper actions against it.

5. Support. Above all else, support your child during this time and involve professional help if you feel like it is necessary. 

Adapted from , 

What if there was a “medicine” that prevented diabetes, heart disease, orthopedic problems, liver disease, mental health disease, and sleep disorders?

Since all of those conditions are related to obesity, preventing obesity is a vital strategy to reduce the risk of those serious medical problems. Incorporating practical tips into your family lifestyle to prevent obesity is an important pill to swallow!! Pediatricians and other primary care providers have a crucial role in obesity prevention, by screening for overweight and obesity and offering practical tips to help with healthy habits from the very beginning.  Early advice and early identification of an unhealthy pattern or growth trend can make a big difference.

It is especially timely to focus on healthy nutrition and physical behaviors because the rate of obesity continues to rise in adults and in children.  One in five children are obese and the rates continue to increase, even though there has been more public health focus on obesity and related health behaviors. Family based interventions are being evaluated, and evidence supports the importance of early intervention since high-risk behaviors start at an early age. Children who are obese are likely to remain at risk for later obesity and medical problems related to obesity.

Practical tips for the whole family:

1. Make healthy food as easily accessible as possible and keep these options readily available: a water pitcher, cut up fruit and vegetables, yogurt, homemade granola, sandwich fixings.

2. Be careful with portion sizes: 10 years ago bagels used to be 3 inches, now they are 6 inches and have 2.5x more calories.  When eating out, share food, eat ½ and bring the rest home to eat later.

3. Eat breakfast: Skipping breakfast has been associated with obesity. Plan ahead for hectic mornings by brainstorming with your family about healthy options that are quick to prepare and, at the very least, easy to eat on the go (smoothies, egg burgers, yogurt with fruit/nuts, PB sandwich)

4. Cook together: You will learn from your children and your children will learn from you. This is important.

5. Limit sugary beverages.  Sugar-sweetened drinks have no benefit and can cause health problems such as obesity, tooth decay and possibly increase risk for heart and liver disease. Limit sugar sweetened drinks to zero!

6. Enjoy screen free dinners: You will eat healthier portion sizes. Reconnect, tell stories, and listen in. A lot happens at the family meal table.

Adapted from Healthychildren.org: Obesity prevention: AAP Policy Explained, by Kelsey Sisti, MD

Skinner, et al. Prevalence of obesity and severe obesity in US children, 1999-2016. Pediatrics 2017:141

From car seats to vaccines, lots of our time as parents and healthcare providers is spent trying to protect our children and patients from potential threats to their health.  Most of this time is focused on threats to their physical health; car seats protect children from dangerous accidents, and vaccines protect against diseases.  But what about emotional threats to our children?  Do we know what they are, and how can we protect our kids against them?  As it turns out, researchers have found that “resilient” children may be better equipped to handle future stressors.  But what does resilience even mean? 

In their Handbook on Resilience in Children, Drs. Sam Goldstein and Robert Brooks define resilience as “the ability to cope with and overcome adversity.”  Basically, resilience is how well our kids can handle tough situations.  And some of those tough situations end up having lasting impact on our children’s health throughout their lifetime.  One 1998 study showed that certain tough childhood experiences can lead to increased risk for major diseases even in your 50’s and 60’s!  They termed these challenging situations “adverse childhood experiences,” or ACEs for short.  From being abused as a child to living with an alcoholic parent or guardian, this study related 10 different ACEs to higher rates of heart disease, mental illness, and even cancer.  If you want to read more about the study, try . 

Even apart from ACEs, childhood stressors can be really tough on kids.  One important thing you can do to help your children deal with challenging events is to give them the toolkit beforehand!  Research shows that children of parents who are supportive and engaged are better able to handle stressors in their lives.  Here are a few important techniques that researchers have discovered:

• Listening to your child’s feelings and try to understand them.  Expressing feelings takes practice!  Engaging your child in discussions about their feelings helps your child learn that it is okay to talk about them.  It can also be helpful for you to understand what they’re feeling and why they feel that way.  Additionally, talking about their feelings helps strengthen the parent-child relationship.  Many parents might find it awkward or challenging to have this conversation with their kids, especially if it’s new to them.  Check out the link below for a helpful article on this.

• Offer to help your child with what they are doing.  This can be anything from play-time to homework.  It helps let your child know that they have a support when things might be tough later on.  For example, if your child is working on a school project, try helping them take it to the next level.  Whether it’s building models or helping with PowerPoint slides, your help can make them feel supported in something they might find particularly challenging.  Plus, it could be fun!

• Being a “responsive” parent.  Basically, this means being in touch with your child’s needs and responding sensitively and consistently.  Before young children can talk, this might be difficult!  But the principle remains the same: practicing “responsive” parenting establishes a solid physical and emotional foundation from which your child can branch out as they learn and grow.  And when challenging events happen in the future, their foundation will help them overcome those challenges. For some more practical suggestions, try this link:

• Help your child by helping yourself.  Research has shown that when parents are dealing with their own mental health struggles, it can also affect their children.  If this is something you are struggling with, remember you are not alone!  If you are feeling down, depressed, or have other mental health concerns, you can always contact your doctor to get help.  It can be good for you and your child!

Helping kids through challenging times can be tough, and hopefully you find these tips helpful in preparing your child to be more resilient.  Here is a resource if your child is having a particularly hard time:

References:

• Goldstein, Sam, and Robert B. Brooks. Resilience in children. New York: Springer, 2005.

• Brotman, Laurie Miller, et al. "An experimental test of parenting practices as a mediator of early childhood physical aggression." Journal of Child Psychology and Psychiatry 50.3 (2009): 235-245.

• Lovejoy, M. Christine, et al. "Development and initial validation of the Parent Behavior Inventory." Psychological Assessment 11.4 (1999): 534.

• Valentino, Kristin, Steven Berkowitz, and Carla Smith Stover. "Parenting behaviors and posttraumatic symptoms in relation to children's symptomatology following a traumatic event." Journal of Traumatic Stress 23.3 (2010): 403-407.

• Felitti, Vincent J., et al. "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study." American journal of preventive medicine 14.4 (1998): 245-258.

Spring is actually here and summer break is on its way! As the weather is warming, try turning off the screens, putting on your sandals, and getting your family outdoors and involved in home-based and community projects.

Being outside can improve your child’s physical health, cognitive skills, and general well-being. Research shows that kids who play outside have lower risks of obesity, improved concentration, and lower stress. But beyond just playing outdoors this summer, why not help your child connect with your community? No matter what the age, community involvement provides your child with more opportunities to interact with others, become more independent, and learn about themselves. Communication skills will affect the way they interact with the world, and it is never too early to start building them. Consider a few of these fresh, fun, and community-friendly projects!

Running a Lemonade Stand

A lemonade stand is a chance for your kids to exercise their creativity, imagination and of course their budding business savvy. Setting up a lemonade stand may seem simple to you, but children will undoubtedly have lots of questions and good ideas. Mixing lemonade (and maybe some baked goods too), designing a sign, and constructing a shop are all part of the learning process! Running a stand gives your children an opportunity to interact with your community and practice communicating with people of all ages. Help prepare them to answer questions about their family business endeavor; for example, how they built the lemonade stand, how they decided on their recipes, and what they will do with their profits! Encourage your children to do most of the work while you are there to offer your advice. Taking ownership will help inspire confidence and help them realize the fruits of their labor.

Garden to Table

Gardening is a fantastic way for your family to get together and experience the outdoors. Whether it’s growing fruits, vegetables, or flowers, planting a garden at home is an engaging way for your children to be active. If you do not have a space for a garden, you can help your children plant a window box with herbs, greens, or flowers.  Imagine your delicious omelets, soups and salads with your homegrown produce!

Being part of a community garden can help children develop awareness about what it means to contribute in a way that impacts more than just themselves, whether that is planting seeds or pear trees, or sharing their harvest with others. Check out your neighborhood resources for a community garden nearby. Or…if you are extra enthusiastic, you can even start your own community garden!

Use your homegrown fruits and vegetables (or support your local farmer’s market*) as the basis for a family meal. Let your children choose what dishes to make from the things they’ve grown. Research shows that gardening can positively affect children’s food choices by improving their nutritional knowledge and increasing their preference for vegetables. Shared family meals have also been shown to reduce childhood obesity and promote healthier eating patterns.

*

Nature Walks

Richard Louv in his book Last Child in the Woods proposed a concept called “nature-deficit disorder”. Louv states that an increasingly urbanized lifestyle has decreased contact with nature for children, and that exposure to nature can reduce stress and be cognitively restorative. If you are looking for something that requires a little less time and effort, consider taking the family outside for a nature walk. It can be at the local state park or the trail in your backyard. There are over 100 trails within ½ hour drive from downtown Chicago. If you want to venture out a bit further, there are many places to go to enjoy a family nature experience in and around Illinois.  Either way, it is a fun way for your family to spend some time together while allowing your kids to reap the benefits of the great outdoors.

Websites to find places to go with your family:

Resources:

Graham H, Beall DL, Lussier M, Mclaughlin P, Zidenberg-cherr S. Use of school gardens in academic instruction. J Nutr Educ Behav. 2005;37(3):147-51.

Hammons AJ, Fiese BH. Is frequency of shared family meals related to the nutritional health of children and adolescents?. Pediatrics. 2011;127(6):e1565-74.

Sharma-brymer V, Bland D. Bringing Nature to Schools to Promote Children's Physical Activity. Sports Med. 2016;46(7):955-62.

Warber SL, Dehudy AA, Bialko MF, Marselle MR, Irvine KN. Addressing "Nature-Deficit Disorder": A Mixed Methods Pilot Study of Young Adults Attending a Wilderness Camp. Evid Based Complement Alternat Med. 2015;2015:651827.

Louv R. Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder. Chapel Hill, NC, USA: Algonquin Books of Chapel Hill; 2005.

Dr. Marc Weissbluth’s first question to the audience at the ĚÇĐÄvlog´ŤĂ˝â€™s evening discussion was, “How many of you have ever been or are currently sleep deprived?" Not surprisingly, everyone's hands went up.  After a discussion of how many uncomfortable physical and emotional symptoms result from being overtired, Dr. Weissbluth reported that the more tired you are, the harder it is to fix a difficult situation.   The common state of “subjective blindness”, or the failure to appreciate our own sleep deprivation, interferes with noticing overtired signs in our children. Dr. Weissbluth’s discussion with our audience, which ranged in age from two months to eighty-two years old, included age-old advice about sleep for the entire family, as well as new research. The information about new research updates our knowledge even since the fourth edition of Dr. Weissbluth’s book, “Healthy Sleep Habits, Happy Child” was published in December 2015.

Dr. Weissbluth says sleep deprivation is “painful and sad”. The good news is that parents can prevent this and the not as good news is that parents can also contribute to this. Some babies naturally seem to cry more than others. Understanding this infant characteristic may help guide parents on their soothing strategies. For example, if a baby cries more, they will have a harder time with self-soothing. Other babies might get more (unnecessary) attention at night, which disrupts their sleep.  For all fussy babies, it is helpful to start working towards self-soothing skills at six weeks of age (from the due date). On the other side of the spectrum, for babies who are less fussy and who cry less can start learning self-soothing skills right from the start, at birth.

Dr. Weissbluth explained there are three components of facilitating self-soothing; putting your baby down when they are drowsy but awake, getting other people involved in baby care (“many hands on”), and offering many naps throughout the day. At six weeks of age (46 weeks from conception) the brain matures in a very predictable fashion.  As a result, this is when a social smile develops and babies need an earlier bedtime. There is a lot going on in the brain of a six-week-old baby!

The next sleep milestone occurs at 3-4 months of age, with the development of regular daytime sleep patterns. Parents should plan most activities around nap times. Again, parents can either prevent sleep problems or contribute to them, depending on how they are looking at a baby’s cues and “signaling” behaviors. Parents should look for early signs of drowsiness (less socially engaging, decreased movement, and slowing down of movement). Waiting for later signs of being tired (droopy eyelids, rubbing eyes, crying) will make it harder for a baby to self-soothe because the baby is already overtired at that point. It is helpful to learn about your baby's’ cues through observation. Overtired babies “fuss and cry and go to a high level of alertness” and therefore be difficult to soothe. Dr Weissbluth pointed out that this is related to a primitive state of man who had to maintain wakefulness to hunt and flee rapidly from predators.

There are several parenting styles that influence infant crying, signaling and waking at night. Parents with a “limit setting” style vs. an “infant demand” style hold their children less, their babies might cry more at two and five weeks of age, but wake up less at night by ten months. Dr. Weissbluth described several soothing techniques (hugging, kissing, rocking, feeding) and emphasized that, “not one size fits all”.  Important variables in this equation include different parenting styles and infant temperament.

Dr. Weissbluth addressed questions about these concepts.

Q and A excerpts include:

Q:  What is self-soothing?

A:  “Drowsy but awake, many hands, many naps”.

Q:  What about exceptions in the schedule?

A:  If parents are careful and have exceptions 1-2 x/months there should not be a problem. If the exceptions are more frequent, it could be a problem.

Q:  What if we missed signs of drowsiness and our baby has a  “second wind”?

A: You should shorten the interval of wakefulness for the next sleep time.

Q:  What is the best way to learn about our baby’s cues and “signaling”?

A:  Ask yourself, “How does your baby look at end of day?” If your baby is overtired, trust your instincts to put your baby to bed earlier. Sleep routines create associations that can be very powerful.

Dr. Weissbluth concluded that different children and different parenting styles have children who sleep differently at different ages. There is not one solution to help children sleep better, but there is one word that helps children sleep better…. and that word is…..(can you guess???)….timing. You begin your efforts to soothe when the early signs of drowsiness begin to appear. The “California” in Dr Weissbluth said that helping your child sleep better is like surfing. “Catching the wave” of drowsiness will help with timing of long naps and easy sleep nights

Dr. Scott Goldstein’s subtitle, and big question, at his discussion about pediatric environmental health at our ĚÇĐÄvlog´ŤĂ˝ Brown Bag Chat on April 19, 2017, was “Is anything not going to kill us?” (His answer was, “Probably not!”) Dr. Goldstein’s goals were to present common pediatric environmental health concerns, to offer practical suggestions to make our homes more environmentally safe and to provide trusted resources for families to learn more about these concerning topics.  He included information about air pollution (inside and outside), carbon monoxide, electric and magnetic fields, tobacco smoke, herbs and dietary supplements, food and radon. 

Please refer to Dr. Goldstein’s slides for comprehensive and concise information about these topics. Included below are some practical tips Dr. Goldstein recommended to help make your family’s environment safer.

As Dr. Goldstein emphasized, children are NOT just small adults and related to the following characteristics, they are more susceptible to environmental concerns: children are closer to the ground, they often put things in their mouth, and the proportion of what they eat and drink per body weight is higher compared to adults. 

Pollution prevention:

1. Have your furnace, stove, and fireplace inspected by a professional regularly.

2. Minimize VOC’s (volatile organic compounds) such as paints and spray cleaners in your home. Open the windows when using these products.  Store them in the garage with proper ventilation

3. Choose products that are recyclable, have reduced flammability/dye/fragrance, choose pumps over aerosols (if your dry cleaning smells like chemicals, try another dry cleaner)

4. Check out Dr. Goldstein’s recipes for household cleaning concoctions for glass cleaner, toilet bowl cleaner and furniture polish (see below)

5. Do not smoke

6. Reduce clutter, carpeting (a reservoir for indoor air pollutants)

7. Increase recycling

8. Encourage a “no shoes inside” policy inside

Carbon monoxide exposure prevention:

1. Recognize sources of carbon monoxide such as car exhaust, space heaters, gas powered water heaters and dryers

2. Look for carbon monoxide detectors with a ULRC label to minimize false alarms

Environmental tobacco smoke (ETS) exposure risk:

1. Do not smoke (did we say that already?!) – encourage NO smoking in ANY structure, including outside windows near where children live

2. Increase awareness that ETS can cause increases in: SIDS, respiratory illnesses, pediatric cavities, missed school days

Herbs, supplements and food safety:

1. Recognize children metabolize herbs and supplements differently than adults and that there are no standards nor FDA rules for these supplements

2. Wash and scrub fruits and vegetables with running water

3. Buy fruits and vegetables in season, eat fresh food rather than canned food

4. If you are choosing organic foods, consider choosing more of the “Dirty Dozen”, although there is no difference in nutrients between organic and non-organic produce and milk products. It is less important to choose organic foods from the “Clean Fifteen” list (see below).

5. To minimize exposure to plasticizers, phthalates, and BPA, choose products that have a recycling code of 1,2,4 and 5 (3,6 and 7 are less safe unless they are “biobased” or “greenware”)

6. Avoid heating in plastic, use glass when possible and buy phthalate-free or EU approved toys

Mercury, noise, and UV light exposure:

1. Eat shrimp, salmon and canned light tuna; avoid fish with high mercury content (shark, mackerel, swordfish, tilefish)

2. For older children, set the volume at 60% of maximum for less than 60 min/day to avoid permanent hearing loss. If your child has headphones on and he/she cannot hear you speak in a conversational voice, the sound is too loud. Headphones are better than ear plugs.

3. Wear sunscreen – at least SPF 30 for all ages [as recommended by the American Academy of Pediatrics (AAP), apply generously (about 1 ounce), every 2 hours, and always after swimming]

4. Wear sunglasses to avoid eye damage (as recommended by AAP, use sunglasses that provide 97-100% protection against both UVA and UVB)

Household Cleaning Cookbook:

Glass cleaner: Mix 1 tablespoon vinegar or lemon juice in 1 quart of water

Toilet Bowl Cleaner: Use a toilet brush and baking soda or vinegar

Furniture Polish: 1 teaspoon lemon juice in 1 pint vegetable oil

Rug deodorizer: sprinkle rug with baking soda, then vacuum after 15minutes

Plant spray: Wipe leaves with mild soap and rinse with water

Helpful Links/Resources:

Air Pollution Prevention

Environmental Protection Agency

Air quality:

Integrated Risk Information System:

Asthma:

Herbs and Dietary Supplements

Lead/Mercury

Sun Safety

kind ¡ness

noun

The quality of being friendly, generous and considerate*

 The signs and symptoms of this condition include an increased level of happiness, an increased sense of wellbeing, improved relationships and improved communication about concerns of relationships. Be careful! This is a very contagious condition. There may even be some inherited tendencies.

 Why does this matter? Because the science behind helping others--or “moral elevation”--supports that acts of kindness increase happiness and wellbeing.

  Taking part in acts of kindness results not only in psychosocial benefits, but also in actual positive physiologic changes.  This may be due to changes in brain function and circuitry. While committing acts of kindness, there is increased frontal cortex activity that creates neural pathways as well as an increased flow of mood elevating hormones and neurotransmitters such as oxytocin and endorphins.

  Perhaps even more surprising, consistent acts of kindness may result in increased health and longevity. Studies show that both the persons performing and receiving the acts of kindness benefit, although the pattern of benefits differ. There may be a decrease in blood pressure, less depression, less stress and even an increase in longevity in people who provide social support to others. That is effective medicine!

 What’s more, kindness is contagious. When people observe others performing acts of kindness they are often inspired to reach out and do something for others themselves. Even Thomas Jefferson in 1771 noted the phenomenon when he wrote to a colleague,“ When any original act of charity or of gratitude, for instance, is presented either to our sight or imagination, we are deeply impressed with its beauty and feel a strong desire in ourselves of doing charitable and grateful acts also.”

 Infants and young children have an innate tendency towards kindness. Children generally enjoy helping others and it makes them happy to be kind. As children get older, their trusting instinct towards kindness is influenced by learned behaviors and cultural experiences. These group experiences influence behaviors of generosity and collaboration. Parental role modeling, as well as community and cultural experiences can continue to promote the instinct to be kind.

  Kindness and gratitude heal our world, one act at a time. How do we develop, promote and sustain this tendency in our children?

1. Be kind to yourself. Be patient and compassionate with you and yourself. This will pave the way towards a happy life and help you be a good role model to your children.

2. Be that role model. Express gratitude, model generosity, and help others who need support both publicly and anonymously. Help your children understand why and when you help others. Discuss opportunities to help others.

3. Play games with your family and friends. Practice taking turns, being a good winner and a good loser in the laboratory of your home.

4. Take it home! Help your children understand the value of taking part in chores to help around the house without being asked (set the table, take out garbage, organize a cabinet, weed the garden)

5. Explore random Acts of Kindness (AoK’s!). Offer praise (be specific) for noticing these acts of kindness. Discuss with your family how it feels to offer and receive these AoK’s. Sometimes, but not always, it can be helpful to use a reward system**.

6. Expend a small effort to show your appreciation for another person’s positive impact. This could be a phone call, a thank you note, or a random note (Yes…with a stamp!), or certainly another social media related message. Thoughtfulness goes a long way. Think about how it makes you feel to drop that letter in the mailbox.

7. Be kind to your neighbors – shovel their sidewalk, rake their leaves, walk their dog, help with a garden, put on a neighborhood variety show, bring brownies to the new kids on the block, entertain with smiley face chalk drawings!

8. Take the kind road. Support family members of all ages to choose compassionate and empathetic responses, even if it is not easy.

9. Promote community service and charitable activities with your family. It will be a win! Win! Situation in so many ways.

*English Oxford Living Dictionary

 
** T.O.P. (Treat Other People) coupon circa 1995, designed by Emily and Joey’s mom (Dr Rebecca Unger).

 
Resources:

   Brown, S, et al. Providing social support may be more beneficial than receiving it. Psychological Science, July 2003. Vol 14 (4).  

   Gregoire, Caroline. Why kindness is contagious, according to science. Healthy Living. May 19, 2015.

   Miller, MC. In praise of gratitude. Harvard Health Publications. October, 2015.

   Piferi,R and Lawler, K. Social support and ambulatory blood pressure: an examination of both receiving and giving. J of Psychophysciology. December, 2006: 62 (2), 328-36.

   Piper, WT, Saslow, LR, Saturn, SR. Autonomic and prefrontal events during moral elevation. Biol Psychology. May 2015: 108, 51-55

   Seligman MEP, et al. "Empirical Validation of Interventions," American Psychologist (July–Aug. 2005): Vol. 60, No. 1, pp. 410–21.

   Simon-Thomas, Emilana. Greater Good: The Science of a Meaningful Life. Is kindness really its own reward? June 1, 2008

Psychologists Drs Michelle Cutler and Emily Arnstein from  joined us at our Brown Bag Chat for parents of . Here is my summary of 5 Takeaways, as described by Drs Cutler and Arnstein, to help parents work together with their children to create and maintain a healthy environment surrounded by technology and social media.

1. It is normal for parents to have fears and anxiety about how to guide our children as we help them navigate the spectrum of benefits and concerns about the use of technology.

We know that there are benefits to our children and to ourselves about learning from the digital world. However, as Dr Cutler and Dr Arnstein said, “we do what we can to make sure our kids don’t miss out on the other crucial skills that the rest of the world teaches us”.  We need to foster time for children to use their imagination and learn about empathy and social connections.  We need to strive towards achieving a balance between technology/screen time and the “other work of childhood…play”.

2. We can make a difference.  The parent -child relationship is the most influential relationship. We need to “set the stage” so our children will discuss their concerns with us.  Our children learn from what they see and hear us doing.  We need to be role models for social communication and making connections. It is hard to learn about empathy and reading social cues from text message conversations.

3. We need to mentor rather than just monitor. We can act proactively to help our children navigate challenges related to technology and social media.  Help your children understand that we all make mistakes and they should not be afraid to come to their parents with concerns and questions.

4. Establish limits, routines and guidelines around use of technology. “As your children grow, they need opportunities to learn to manage new challenges”.

5. You are not alone. Recognize when your family needs additional help. Understand the value of a respectful relationship with your children that can be a “foundation to guide them”.  Understand what your resources are, and talk to other parents about how they manage their family’s issues. Seek out counseling and professional help if you think your child is being “affected by technology in and unsafe or unhealthy way”.

A few more tips:

• Give an early message to your children that you will be involved.

• Encourage your children to talk openly about their experiences.

• Foster technology skills together. Ask your children to help you set up social media accounts and teach you how to use them.

• When you communicate to your children that something is inappropriate, tell them the specific reason why.

• Consider making a contract with your children about guidelines and limits. Use logical consequences if the contract is not followed.

• Help your child understand that what is right for your family might be different from their friends’ families. It is OK to be the bad guy and enforce limits both with your children and possibly with your children’s friends when they are in your home.

Resources

• Reclaiming Conversation: The Power of Talk in a Digital Age by Sherry Turkle

• The Shallows: What the Internet is Doing to our Brains by Nicholas G. Carr

• Screenwise: Helping Kids Thrive (and Survive) in their Digital World by Devorah Heitner

• Commonsensemedia.org – a nonprofit organization that offers unbiased information to children, parents, educators and policy makers about media and technology

Welcome to our Share the Health blog! The Neighborhood Parent Network (NPNparents.org) implemented an Ask the Expert Discussion Forum about several family friendly topics. I participated as the expert in the discussion forum about nutrition. The NPN members submitted questions about nutrition and I answered the questions which were posted on the NPN website. It was an informative way to share information. Luckily I had help from my colleague, Linda Somers, a dietician from the Lurie Children’s Hospital. Linda and I have been working together and counseling overweight and obese patients for more than 25 years in the Lurie Wellness and Weight Management Clinic. Here are some of the questions and answers from the Neighborhood Parent Network discussion forum.  This first post covers questions and answers about picky eaters. Stay tuned for our next post which covers topics to help you make healthy food choices for your family.

When I was a kid, if I didn’t want to eat my dinner, I would go to bed hungry. Of course, I don’t want to be a short order cook (for my 3 year old) but I also don’t want him waking up in the middle of the night complaining that he’s hungry. I’d love some guidance on how to handle pick eating particularly at dinner time.

This is one of my favorite questions! It is important for families to eat meals together, whenever possible. There is a lot of communication and learning that goes on during family meals. That being said, it can be tricky to keep a toddler from turning up his nose at what is served for dinner.  It is important to NOT be a short order cook. As a general rule, a parent or caregiver should provide a healthy meal, and the child should decide what to eat. If you know that your child might not like what you are making for dinner, you can include in the initial offering of what is put on the table a side dish that you know your child will eat.

Even when your children are very young, it is helpful to promote an enjoyable atmosphere during mealtime. Parents and caregivers should role model good eating and communication habits as much as possible. Kim John Payne and Lisa M. Ross even suggest lighting a candle during family meals in the book Simplicity Parenting.

The good news is that children change their ways when they are repeatedly presented with foods that initially are undesirable. With a cheerleading section and good role modeling to encourage your child to eat broccoli, she will eventually learn to like her broccoli. Studies have shown that if you offer the same undesired food 14 times, a child will eventually learn to like it.  The moral of this tale is that you should not give up!

As for your concern about going to bed hungry, if your child exhibits undesirable behavior at the dinner table, such as refusing to eat his meal, you should calmly tell him that his meal is over and get him down from the family dinner table. Meanwhile, it is helpful for him to observe how much fun the rest of the family is having at the dinner table from which he was just removed. You should explain to him briefly and calmly why he is not allowed at the table. Before bed, you can offer your child a “before bed snack”, which can be hearty enough to make sure he is not going to bed hungry. An example of a bedtime snack in this situation is yogurt with fruit. Your child does not have to know that his bedtime snack was more substantial because he did not eat his dinner. That is one of our parental secrets!

In their school lunch my kids will only eat ham sandwiches on sub buns. We alternate whole wheat buns (my choice) with white bread buns (their choice) every week. How bad is this lunch? How hard do I have to fight to get them to mix it up a little bit, or at least stick to whole wheat buns? They usually eat their vegetables at dinner, so at least there’s that….

Three regular meals/day contributes to a healthy eating pattern. Packing a school lunch is a parental labor of love. I like the idea of “picking your battles”. Much of where you end up with your choices depends on your child’s eating habits during the nonschool parts of the day, weight to height proportion and activity level. Assuming your child has healthy eating patterns at home and a healthy weight to height proportion, I think that offering whole grains is optimal but alternating with white bread buns is reasonable if that is what it takes to get your child to eat lunch. Reaching that compromise is much better than fighting for the whole-ly whole wheat.

Ideally children should eat at least five fruits and vegetables/day. It is a good idea to offer fruits and/or vegetables with every meal and snack, which would include a school lunch. Whether your child eats the fruit in her lunch bag or trades it away is out of your control!

My child (3 years) gags when she eats yogurt and will drink milk only when forced to.  I am trying to find creative ways to get calcium down her (although she does love cheese!) as she has this aversion to creamy things.  Thanks in advance for your suggestions!

Children are commonly deficient in calcium and vitamin D intake. The calcium recommendations for children are: 700 mg for 1-3 year olds, 1000 mg for 4-8 year olds and 1300 mg for 9-18 year olds. The vitamin D recommendations are 400 IU for infants and at least 600 IU for children over 1 year of age. The calcium and vitamin D intake in childhood affects bone health later on in life so it is important to be creative about calcium and vitamin D intake.

An 8 ounce glass of milk contains 300 mg of calcium and about 100 IU of vitamin D. Keep in mind that children two years and older should drink a low fat milk (either skim or 1 %). Calcium can be found in other foods such as cheese, yogurt, leafy green vegetables, fish, chickpeas, nuts and even blackstrap molasses.  Vitamin D is harder to find in other foods although it may be in some yogurt and yogurt drinks. It is a good idea to check labels for products that have the nutrients you are looking for. Although juice is not recommended, a small amount of calcium and vitamin D fortified orange juice can contribute to meeting calcium and vitamin D needs. A multivitamin, calcium/vitamin D supplement or a plain vitamin D supplement can also help meet your child’s needs.

There are other milk free foods that are calcium and vitamin D fortified such as rice, hemp, almond, coconut and soy milk. If your child has a dairy allergy it is a good idea to talk to your health care provider and your allergist to discuss these dairy free options. A helpful website for food allergies is Food Allergy Research and Education (FARE.org).

Creative ways to encourage calcium and vitamin D intake:

• Make smoothies with an appropriate type of milk for your child and include green leafy vegetables in your recipe. If you do not add too much of the green vegetables, your child might never know what you are sneaking into the smoothie! Using frozen fruit is helpful to make the smoothie taste cold and fresh.

• Freeze yogurt in popsicle trays. Encourage your child to help make this healthy dessert/snack. Add cut up fruit to make it even more nutritious.

• Add green leafy vegetables to your soups and sauces. Use a blender to hide those green foods.

Resource: American Academy of Pediatrics, Committee on Nutrition, 2014

Another picky-eating question! If my kids don’t eat what I’ve cooked for dinner I sometimes let them leave the table even though they have hardly eaten anything – and they don’t get anything else to eat before bed. Is there is a different strategy that you recommend? When they’ve gone to bed basically skipping dinner, should I make up their calories and nutrition at breakfast the next morning? My kids are very petit – 6 and 8 year old boys who each weigh about 43 pounds. Thanks!

Question on a 3yr old picky eater: She won’t eat vegetables. Tried every possible ways (mashed etc) with no success. I keep presenting it over and over without forcing and with the ultimate hope that one day she will eat it? Any suggestions? Thanks!

It sounds like your daughter read the book on how to be a three year old. It is very common for children to develop picky eating habits at that age. My suggestion is to keep trying! If your child has a normal weight to height proportion then you can use this at your motto:

PARENTS/CAREGIVERS PROVIDE, CHILDREN DECIDE

If you continue to offer healthy choices, including the undesired vegetables, with good role modeling during family meals, eventually your child will change her taste and texture preferences. Meanwhile, you can give her a children’s multivitamin to make up for her decreased vegetable intake. It might also be helpful to include your daughter in meal preparation. Sometimes that can help break down the vegetable strike. Inviting others to your dinner table can also help provide role models of all ages to encourage your child to try new foods.

Karen Pierce, MD, a clinical associate professor of psychiatry at Northwestern University, joined us at our Brown Bag Chat to talk about strategies and tools to help parents and families identify and manage anxiety. Here is some information from our discussion with Dr Pierce. The concepts Dr Pierce discussed relate both to parents and children.

Why do we worry?

We worry because it is our mammalian instinct to try to protect ourselves and our families from fear and harm. It is a yellow light of caution. Usually it is not a green or red light but rather a coping strategy that helps us pay attention. In most circumstance it does not stop us from doing our regular activities. It becomes a red light when we are not able to do those regular activities.

What is normal?

Worry is normal. Worry and anxiety can be good even though they can cause physical symptoms such as stomach ache and headache. Exposure to anxiety helps you learn that you are ok and you can learn from how you deal with your situations. Worry and anxiety are not normal when you cannot do your regular activities such as eat, sleep and go to school.

What can we do?

• Do not reassure your child that there is nothing to worry about. Acknowledge fears and help your child learn how to handle the fears to build resiliency. It is ok to say that anxiety and worry are scary.

• Let go of anxiety. Worry and fear are natural reactions. Help your child realize he has choices and he can be in charge of how he thinks and feels.

• Talk about how worry is ok. It can motivate us to do our best.

• Bring worry to life. Consider role playing to help your child understand what tools she has to deal with her anxiety.

• Be a “thought detective.” Ask and talk about “nutty thinking” which may escalate thoughts and conversation. Help your child calm down, help yourself calm down, and then work on problem solving.

• Breathe. Teach your child how to breathe deeply to help learn to pause, and then process. Learning mindfulness is good medicine.

• Let kids worry. Your child has more information than you do about his anxiety. By guiding your child to solve his own problem, he will learn a lot. This is the beginning of learning about empathy.

• “Avoid avoiding” things that make your child nervous.

• Be compassionate and respectful of each person’s understanding of their own anxiety. Do not be judgmental.

When do you need more help?

These above tools teach mindfulness, resilience, and problem solving techniques that can be part of everyday life. They can be helpful for the entire family. However when your child avoids certain activities or events because of anxiety and fear about what can go wrong, it is time for more help. Therapists often use cognitive behavior therapy (CBT) to treat anxiety. This therapy provides both short and long term benefits to help children (and adults) learn skills to manage anxiety and the physical symptoms that go along with anxiety.

The three related points of the CBT triangle include: 1) Thoughts 2) Behaviors and 3) Feelings. Under most circumstances, these can all be controlled. Children can learn to understand their fears so they can tackle the least fearful things before they have to face the most fearful things. Whether these tools can be taught within the family at home or whether there is a need for outside support depends on the individual situation. Your child and family may benefit from talking to your doctor, seeing a counselor or therapist, and/or collaborating with other families and parents.

The pediatrician’s perspective

As pediatricians, we screen for health concerns at each visit from our first prenatal or newborn visit through the early college years. We also provide information to families about what to expect from one visit to the next.

Similar to screening and counseling about nutrition, sleep, development, dental health, and bike helmets, addressing concerns about a child’s worries and anxieties should be part of each well child visit. By paying attention to these concerns early on, it can be easier to help your child develop tools in her mental health toolbox.

Suggested books:

What Does It Mean To Be Present by Rana DiOrio

A Boy And A Bear: A Relaxation Story by Lori Lite

KidStress by Georgia Witkin

Freeing Yourself From Anxiety by Tamar Chansky

Freeing Your Child From Anxiety by Tamar Chansky

Providing healthy yet tasty snacks is one of the true arts of parenting. It is right up there with creating thoughtful birthday goodie bags. The article from the Washington Post, No, Your Kid May Not Have A Snack by Amanda Kolson Hurley was recently posted on our Facebook page. It importantly highlights concerns about unhealthy snack patterns.

In general, portion size, including what is put on our table and what is carried around in the diaper bag, stroller, or backpack, is increasing. Also, access to unhealthy food options is increasingly more convenient and parents are eager to keep their children happy and well fed.

As stated in the article, children are snacking more often and consuming almost 40% more calories from snacks compared to several decades ago. The prevalence of obesity in children continues to rise. As pediatricians, we have the golden opportunity to facilitate small changes that might make a difference in growth patterns.

The entrance into summer brings a change in schedules and eating opportunities. This may result in either a more organized eating pattern or the opposite! As a follow up to this article, here are some practical tips for families as we exit from the school year and welcome a new season.

As a general guideline, children and families should eat three regular meals each day. Grazing on snacks throughout the day is not recommended, however it is important to give children two planned out and healthy snacks (mid-morning and mid-afternoon) each day . This is not new news but it is a good reminder to help your family avoid grazing throughout the day. There is nothing like a day of eating cracker-y snacks to curb an appetite for a family meal.

Here are a few ideas to keep it simple:

• Snacks should always include a fruit or vegetable.

• Try to include several food groups in each snack.

• Check to make sure the grains you give to your family have at least 3 grams of fiber per serving.

• Avoid second helpings except for fruits and vegetables.

• Avoid sugary beverages during snacks – this includes sports drinks which are generally not needed unless your child is involved in extreme sports.

• Keep a list of healthy and preferred options on the fridge so your family has easy access to healthy choice ideas.

• Ignore temper tantrums related to food (and everything else!

• Plan ahead for healthy snacks when you are out and about.

Sources:

American Academy of Pediatrics

Healthychildren.org

Dietary Guidelines for Americans

http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf

Dana Hirt, a parenting coach (danahirtparenting@gmail.com) came to our Brown Bag Lunch Chat series on November 6, 2015 to talk about Intentional Parenting. We discussed how it is never too early to talk and share ideas about making mindful decisions based on your values and what kind of parent you want to be. It is advisable to start using intentional parenting techniques when your children are young so you can establish healthy connections from the start. How young is young? Similar to establishing healthy feeding and sleeping patterns during infancy, knowing how to be a mindful parent from the start can help you care for your children and yourself in a healthful and thoughtful way.  

Dana talked about three techniques to help care for your children and yourselves:

• Parent vs Person Dynamic: We need to care for ourselves while we are caring for our children. Be aware of your needs as a parent and as a person. Ask yourself how you can feel supported and empowered to take care of your children’s needs while you are also paying attention to your own needs. Dana reminded us, “You can’t take care of yourself at the expense of your children, and you can’t take care of your children at the expense of yourself.”

• Honesty: Regulated and Modulated: The approach to providing information to your child should be developmentally appropriate. When your child asks a question, you might ask your child about what he/she is looking to know.

• What You Do Matters: Children watch what we do more effectively than what we say. It is important to help our children be resilient and give them skills to navigate their way. There is a balance between being there to support your children and helping them learn to solve problems on their own.

Dana reminded us of some advice from Ralph Waldo Emerson:

“What you do speaks so loudly that I can’t hear what you say.”

What does this mean for our parenting strategies? Here are some practical ideas for parents of children of all ages:

• Think about the kind of parent you want to be. Talk to other parents whom you admire about what works and what does not work.

• Help your child join “The Golden Rule Club”. Encourage kindness inside and outside of your family home. Be a role model and also give specific feedback to help your children understand your expectations and priorities.

• Do not be afraid to set limits and routines. The structure can feel helpful to your family.

• It is important to listen to your children’s ideas and facilitate open communication. As your children get older, they might know better than you do when the family rules might be changed. Of course, parents have the final word!

• Share your thoughts. Be a role model for your children to say what is on your mind when it is developmentally appropriate.

• Pick your battles with your child. Stay calm when discussing issues. This will help your child learn to do the same.

• Spend time with your child. Facilitate what your child likes to do. If your child likes to see the zebras at the zoo…go to the zoo, read books together about zebras, draw pictures of zebras. You do not have to spend equal time with each child as they will have different needs at different times.

• Understand that you do not have to make it to every soccer game. It is helpful for your child to observe that you prioritize for yourself at times….your work, your health, your fitness. It is an important balancing act to take care of yourself while taking care of your family.

• Unplug at mealtimes. Focus on interesting conversation during your family meals. Do not ask, “How was your day?”. Ask more focused and thoughtful questions such as:

What made you laugh today?

What interesting questions did you hear people ask today?

What was the best part of your day? What was the worst?

What could you have done better today?

Be sure to share aspects of your day with your child/ren. This helps remind us of the parent vs person conversation and models interactive relationships for our children.   

Hold on tight! The custodial parenting years fly by quickly. By planting the seeds of resilience and developmentally appropriate self-agency, you will optimize the launching of kind, strong, and thoughtful individuals.

A review of studies about family meals indicates that frequent family meals are not only associated with better nutritional value and meal structure, but also many positive psychosocial outcomes. Shared family meals have higher intake of fruits, vegetables, whole grains and fiber as well as less intake of sugary beverages. Studies also show that family meals are associated with lower risk for childhood obesity.

Family meals are positively associated with increased self-esteem and school success. Frequent family meals are associated with less frequent eating disordered behaviors, alcohol and substance abuse, violent behavior and feelings of depression and suicide. Those benefits are hard to beat!

As part of the Prescription for Healthy Active Living, the American Academy of Pediatrics recommends preparing meals at home as often as possible and eating family meals 5-6 times per week. Similar to other behavior patterns and priorities such as ignoring temper tantrums and establishing healthy sleep habits, it is easier to establish your family healthy meal habits early on. A lot of role modeling and social conversation happens at the table, so it makes sense to gather ‘round the table as soon as your child is eating meals. This practice might bring about a change in adult eating patterns (earlier dinners, more regular meals, more meal planning) which will most likely benefit the whole family. Of course, shared meals will not happen every night, but it is a good idea to keep the intention on the front burner!

Add some special ideas to keep your family meals enticing. You do not have to wait for a birthday to light candles. As described in Simplicity Parenting by Kim John Payne and Lisa Ross, children should have candlelight every day. Why not light “fire fairies” at the dinner table as a routine part of your mealtime? Other ideas to keep your shared meals inviting include setting a nice table with a tablecloth or fun placemats (or have a picnic), or set some funny rules throughout the meal (eat with only 1 hand, sing songs or make up rhymes for the whole meal!). Keep a family box of funny conversation topics and pick from the box to spice up the conversation!

Nutrition tips for shared meals:

Do not be a short order cook – you provide and your child decides what to eat.

Offer several food groups at each meal

Watch portion size – second helpings should just be fruits and vegetables.

Include high fiber foods (at least 3 grams of fiber per serving).

Behavior tips:

Encourage desired behaviors – catch ‘em being good!

Discourage undesired behaviors – ignore temper tantrums, calmly take your child down from the table if she/he throws food.

Be consistent – you can always make up for a bad meal with a planned out healthy snack if your child misses a meal related to undesired behavior issues.

Our goals for families are to share healthy meals, encourage healthy sleep patterns, read together, ensure good role models, be active daily, and help parents balance work and home life! Piecing this together is a challenge all families encounter. It is a lot to ask from a family, but families and friends can learn from each other. It may also be helpful to reach out to other professionals to help develop effective strategies. It is definitely a work in progress for a lifetime!

Recipes for Fun: Meal Related Activities Combined with Family Friendly Recipe Ideas

1. Farmer’s Market Fruit Salad with A New Twist

Activity: Go to a local farmer’s market and let your children pick a fruit that they have never eaten, along with other preferred fruits.

Recipe: Go home, cut it all up and serve!

1. Special Oatmeal Pancakes

Activity: Go to the grocery store and pick out toppings for pancakes (berries, yogurt, syrup, sprinkles).

Recipe: Toast 1 cup of steel cut oats in a pan, then put in blender. Combine blended oats with 1 cup of flour, 2 cups of buttermilk, 2 eggs, 2 T brown sugar, 1 tsp vanilla, 1 tsp baking soda and ½ tsp baking powder and make pancakes!

1. Strawberries and Cream Popsicles

Activity: Go strawberry picking

Recipe: In a blender or food processor, puree 1 pound of strawberries, add some sugar to taste, add ½ cup heavy cream, fill popsicle molds, add sticks, and then transfer to the freezer overnight. Enjoy popsicles the next day!

1. Top Secret Salad Dressing

Activity: Grow greens in your garden (kale, collards, spinach, chard) in a pot on your porch or even in a window box. Add your own greens to your other favorite salad ingredients

Recipe: Combine oil and vinegar (twice as much vinegar vs oil), add seasonal herbs (that is the secret part!).

1. Guacamole Sundae

Activity: Make tortillas*

Recipe idea: Mash together avocado, tomato, onion or green onion, salt, and any of your other favorite ingredients.

*Tortilla recipe

Preheat oven to 400 degrees. Stack tortillas and use kitchen scissors to cut into 4 pieces like cutting up a pizza.

Spread them in a single layer on a cookie sheet at least 1/4 “ apart.

Season with salt or other desired toppings (chili powder, cumin, pepper, cheese).

Bake 8-12 minutes or until chips start to get crispy and golden around the edges.

Remove from the oven and let them sit for 5-10 minutes to fully crispen.

Adapted from www.food.com

Resources

Fulkerson, JA, et al. A Review of associations between family or shared meal frequency and dietary and weight status outcomes across the lifespan. .Journal of

Nutrition Education and Behavior 2014:;46 (1): 2-19.

Harrison, M et al. Systematic review of the effects of family meal frequency on psychosocial outcomes in youth. Canadian Family Physician. 2015; Vol 61:596-105.

Larson, et al. Family meals during adolescence are associated with highter diet quality and healthful meal patterns during young childhood. J Am Diet Assoc 2007; 107 (9): 1502-10.

Larson, etal. Eating breakfast and dinner together as a family: associations with sociodemographic characteristics and implications for diet quality and weight status. J Acad Nutr Diet 2013; 113 (12).

Bright Futures Guidelines, American Academy of Pediatrics. https://brightfutures.aap.org

Written by Terry Kass and Rebecca Unger, MD

Ready for an adventure? Looking for a family activity that tickles everyone’s fancy? Want to run away from screen time for an afternoon?

Go to an art museum. Whether you picture you (or your children) as art museum goers or not, this will be a rewarding outing for all. Take the whole family or go on a mini family bonding outing (mother/daughter, mother/son, father/daughter, or father/son)!

Go to an art exhibit with age appropriate expectations.  Each visit should feel like a wonderful and playful experience.  Make a game of it!

Preschoolers:

Never stay more than an hour with a preschooler. Leave them wanting more.

Create your own scavenger hunt. For example, ask your child to point out pictures with specific animals. At the Art Institute of Chicago, as you walk to see A Sunday Afternoon on the Island of La Grande Jatte by Georges Seurat, ask your child to point out a picture with a dog and a monkey. When you get there, celebrate finding it. Enjoy seeing the little dots of color that make up the picture. Look at it close up and from far away then close up again.

After seeing the La Grande Jatte which has umbrellas but no rain, look for a nearby picture, Paris Street; Rainy Day by Gustave Caillebotte, which has umbrellas and rain.

Talk about how the pictures make you feel. Are they happy or sad feelings? The answer is not important, but talking about art and how that translates to feelings of the viewer is wonderful.

Alphabet fun and art are a great combination. Walk into a gallery of a modern art exhibit and ask your child to go stand in front of the picture by Picasso. Tell them to look for a “P” in the signature. Let them run over to it. Next challenge them to find the picture by Miro by looking to the big “M”.  Matisse, Kandinsky, Chagall and many others have nice large signatures for children to find. They do not need to be readers to enjoy this game. For the very young, focus on the first letter of the child’s name.

Play “Same and Different” with your children. Go find the Haystacks by Claude Monet. Talk with your child about how they are the same and different. You might mention light and color, seasons and time of day, but do not do all of the talking. Let your children come up with their own ideas.

Pick a color and focus on that during a museum visit. Tell your child you are looking for a blue painting and you hope to find a picture from Picasso’s blue period.  Go to the gallery with Picasso’s The Old Guitarist. Search for other blue tones in places like the Chagall Windows or in Georgia O’Keeffe’s Blue and Green Music.  Pictures of landscapes with water will make picking blue a great choice.

Elementary Aged children:

Even though slightly older children have a longer attention span, do not presume too much. Always leave them wanting more. It should still feel like an adventure every time they go to an art museum.

Let your child help navigate using the museum’s map. Demonstrate good behavior by politely asking a museum guard for directions. Even if you are on the right track, you can confirm that you are going the right way.  Learning to ask for help (and knowing who to ask) is a life skill. Mention things like “Exit” signs and bathroom signs. Navigating public spaces becomes less daunting when children realize the symbols are similar in museums, airports, movie theaters etc.

Engage your child by focusing on things he/she likes. Pick something and maybe (maybe not!) go with that for the entire visit such as boats, flowers or animals. You can encourage discussion about how they are depicted in the art. For a reluctant museum-goer, letting them pick the object is a great way to launch the adventure.

Play the “Favorite” game. Walk into a gallery room and ask each child to go stand in front of the painting they like best. Repeat in a couple of different rooms so they can have multiple “favorites” throughout the museum.  It is acceptable to like some art better than others. Encourage them to have an opinion and respect other people’s choices. By showing that you like different things that they like, you are encouraging them to trust their own instincts and be proud of their choices.  Learning to respect other people’s opinions is a gift. Help them read the name of the artists they like best.  Repeat those artists’ names on your way out of the museum and when you get back home. That night, ask your child the name of the artist he liked best and see if he can remember. Try to bring up the artist again in the following weeks and months. The next time you return, see if the favorite is in the same place or moved elsewhere. Also, ask if the child still likes it or has a new favorite.

Dates of artwork can be fascinating. It is also interesting to “play” with dates as a math tool. It is fun to find art that is over 100 years old. Depending on the age of the child, they can do subtraction to find out how long ago the painting was completed. This math concept strengthens the idea that most things have an age even if it never changes. For older children, it can be interesting to find two paintings in a room by the same artist and try to guess which one was completed before the other. The “Which Came First” game is great for children old enough to understand time and dates. The idea that artists change their style over time makes it fun for the children to run up and check out the dates of the artwork.

Many artists have both paintings and sculptures in the same museum. Finding those can make a museum visit very interesting for children who are learning to use many mediums in their school art classes. Alberto Giacometti and Pablo Picasso are two excellent examples at the Art Institute of Chicago. Talk about their similarities and differences between the paintings and sculptures.

Give your child the gift of trying to draw what she sees. Bring paper and writing utensils. Every museum is different, so check before you go there. Some allow only pencils and other are less restrictive. Allow your child (and yourself) the time to sit on the floor in front of a work of art and try to draw what they see. Do this in two or three different rooms with very different styles such as the distinct styles of Piet Mondrian (picture the Partridge Family bus), Mark Rothko (think of stacked rectangles) or Andy Warhol.  It can be fun to copy a cubist painting. The results will astonish you. It also reinforces to your child that there are a lot of ways to create art and that not only “perfect” likeness gets appreciated.

Globetrotting: Focus on various artists’ country of birth. Depending on the age of the child this game can take many forms. Guessing an artist’s country and going over to see if you are right is fun. Count how any different countries are represented in a particular room. It is also fun to find two different artists from the same country who paint very differently.

Play the “What’s The Story” game. Get your child to describe what is going on in the scene. Looking at Mary Cassatt’s The Child’s Bathinvites a discussion of the time period. Children will enjoy talking about their own dance classes while viewing a Degas ballet painting. Pictures like Edward Hopper’s Nighthawks invite speculation for older kids to make up the conversation of the people depicted in the painting of the restaurant.

Beware of the museum store. Like an amusement park, many museums funnel you through or past their shop to get out of an exhibit so it is tempting to go shopping. The stores tend to be expensive so you may want to set the precedent that sometimes the shops are for looking not buying. Alternatively, encouraging your child to pick a small souvenir, like a postcard of one of their favorite paintings, can be a happy compromise, and a simple reminder about their adventurous day at the museum.

The key to children enjoying a museum is for them to enjoy visiting with people they like. Your enthusiasm for the adventure will be contagious. If you are excited and have fun, they will also be excited and have fun, and the memories will last a lifetime. You can be sure that museum going is inherited! It is a priority and an adventure that is often passed down from one generation to the next.

Children get a lot of information about their changing bodies from many avenues. They learn, for better or for worse, from their peers, teachers and family members…and of course from a variety of media sources. The conversation about sensitive topics is a life-long conversation that starts at any age, by responding to questions and inquiries from your child about his/her observations.

Besides the ongoing conversation with your curious child, and before your child has his/her Sex Ed lecture(s) at school, it is a good idea to talk with your child about their changing body and your family values. By getting to your child before the school program does, your child will have heard it all from you, firsthand. This can feel very supportive and can help your child understand the what and why of your family’s perspective. This way, during the school program, your child will be sitting in his/her seat, armed with thoughtful background information, and will be able to learn more, and more comfortably, about these sensitive topics regarding self-care, self-esteem, and self-protection.

It is not easy to know how to talk to your child about his/her changing body and changing world. It is important to consistently engage in this ongoing conversation to make sure your child gets the facts straight and timely. Dr. Rebecca Unger and Dr. Tim Blegen talk to parenting.com about how to talk to preteens about their bodies.

For girls:

For boys: