You likely heard that Massachusetts is finally considering an anti-bullying law. It’s about time!

My kids have both been bullied over the years…have yours? It is one of the most challenging situations to handle in all of parenting and the dramatic increase in technology among today’s kids and teens and made bullying via technology a contributing factor. 25% of kids being bullied is too many already. 42% of kids being cyber-bullied is unthinkable…but is the estimated number being victimized via technology.

The impact of bullying on my kids lives wasn’t readily evident until I asked my 12 year old some questions for a book I was working on. I asked her the following question: “What are the biggest threats to your childhood today?” I had asked that to her older sister, almost 16, and heard answers such as too much homework, not enough time for friends and family, too much use of technology, too much pressure. My 12 year old turned to me and said “Bullies. I was bullied and it took something from me. It could happen again, you know.”

Of my two girls, she had the worst of the bullying and one of the situations was recent. We had thought she had “dealt with it” but clearly it was still plaguing her…she was almost carrying it around like a permanent tattoo, just under the skin, out of site, but palpable.

What we fail to realize as parents it that kids don’t categorize situations as we do. Situations we view as “not bad” or “mild” are still incredibly painful. In fact, in the case of bullying, all bullying hurts and its extremely challenging to categorize it. We can look back after the fact in some cases, such as the tragic suicide death of Phoebe Phoenix of South Hadley High School in South Hadley, Massachusetts, and recognize how intense that was with nothing being done.  However, all bullying is intense and does escalate. That means that we have to pay attention to each and every report of bullying and stop it before it gets to the point of no return for the victim and before they feel so helpless that he or she reaches for some extreme cry for help, as Phoebe did. Those extreme cries for help mean that the system and adults within that system have let that child down and failed to protect that child.

Massachusetts passing an anti-bullying law is an important measure but will mean nothing if schools and communities don’t do better in listening to children and protecting them when they turn to a trusted adult and say “I need help…I’ve been bullied”.

Bullying is a violent act. It’s time we take a stand for all our kids and simply say “No more! This ends today.”

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Nicknames: Hayfever, Allergies

What it is: allergic reaction to something in the environment such as pollen, dust, molds, animal hai. It is an overreaction of the immune system – a “normal” reaction on overload. People can grow in and out of allergies throughout their lives. Genetics determines some predisposition but environmental factors can also overload the immune system.

Seasonal Issues:

Many people have season allergies particularly around season change times. Some people are allergen specific and others have year ’round allergies.

Symptoms:

Symptoms are different person to person but include some of the following:

• runny nose
• sneezing
• itchy skin
• watery eyes that may appear red
• wheezing or cough

Treatment:

Symptoms specific and may include:

• avoidance if possible of offending allergen (eg. if allergic to cats, avoid cats)
• antihistamines: over the counter and prescritpion
• expectorant for nasal congestion
• saline nose spray
• eye drops
• other medications as indicated by symptoms

When to Call Your Doctor

• symptoms interfering with activities
• symtpoms interfering with sleep
• trouble breathing
• worsening itchy rash

Internet Resources for Parents

All About Allergies (KidsHealth)

Internet Resources for Teens and Kids

For Teens

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I recall one 17 year old teenager who had threatened to commit suicide earlier that day.  I remember being struck by two observations: how sad she appeared and how “normal” her family was by all standards. They were basically like any of our neighbors.

Talking to this particular teenager, I learned she had great success in school, sports and music and appeared to have a very loving and supportive family. Yet, she never felt happy…ever. Her parents described her to me as a “serious” teenager and very busy, burning the candle at both ends and feeling enormous pressure about the college application process.

That particular day, she decided the world would be better off without her and it frightened her so much she told one of her high school teachers.  After the initial shock of the moment, her parents and teachers were able to look back and notice small clues that were missed by this teens outward success that lead to that day. Thankfully, they knew to bring her in for a crisis evaluation and the team on-call agreed she was clinically depressed and needed in-patient care. Finding that care was a different story with the usual bed crunch we have in the child psychiatry world but at least in this case we had a family on board with care and a teen wanting help. These situations don’t always occur this way.

What makes teen depression so challenging is teens are moody and can have off days. So, how do we decide if our teen is “clinically” depressed or just going through a short term rough patch, perhaps due to t a friendship issue or issue with a boyfriend or girl friend, or simply having a bad day?

Keep in mind that most teens, despite their reputation as a group, do listen to adults and follow the rules. Remember, a busy teen is a happy teen most of the time. What we have to look for is a flip-flopping of emotions where the teen’s mood shifts from being mostly cooperative and happy to mostly not so cooperative and unhappy. In other words, instead of the teen melodrama being the exception and fleeting, it becomes more persistent and prevailing and lasts at least 2 weeks, if not more. That’s the point we have to pause and get our teen evaluated.

www.aboutourkids.org has a list of screening questions that can help you decide whether you may need to seek professional help for your child. Keep in mind that a “screening” test picks up kids who MIGHT have a problem – kids you want to have someone else look at – but it may not mean that there is a HUGE problem.

1. Does your child feel sad, blue, or tearful?
2. Is your child often angry or picks fights at school or at home?
3. Does your child no longer care about favorite activities?
4. Has your child lost or gained a lot of weight?
5. Does your child have trouble sleeping or sleeps too much?
6. Does your child have trouble sitting still or appears very slowed down?
7. Does your child always look tired or is “too tired to play”?
8. Does your child feel hopeless or tell you, “I’m no good?”
9. Does your child have trouble concentrating or making small decisions?
10. Does your child talk about how life is not worth living, death, or suicide?
11. Have you noticed these symptoms have been present for almost every day for a 2 week period?
12. Do these problems get in the way of activities at home, in school, or with friends?

If your teen is clinically depressed, you will have a large peak to climb – but don’t let that deter you. There will be peaks and valleys as you help your teen battle this beast but keep the ultimate peak, the gold ring in mind to keep you focused: the smile on your child’s face that you’ve likely not seen in all too long a time.

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While today’s system is far from perfect, there is still a lot we can do to get the care we need. Instead of blindly accepting the system as is, we can become more empowered and partner with our physicians as advocates of our own health care, and those of our loved ones such as our kids. This means speaking up when we have questions and becoming more health literate. This also means working with our physicians to be sure the treatment we receive works for our lives. To accomplish this, we may have to seek more than one opinion on a health matter, and that’s not only ok to do but possible even in today’s chaotic health climate.

All too often I see people settle for treatment plans they are not comfortable with instead of pushing their current doctor for alternatives or seeking an alternative opinion. After going through my own health hurdles the last two years, some medical and one surgical, I can attest to the value of asking questions, seeking additional opinions and even switching primary care doctors if needed.

The goal isn’t to find someone to give you the answer you seek but to find someone who will take the time to listen and help you find the answer to what’s going on in a way that makes you feel comfortable with the result, whatever it is. Sometimes accomplishing that requires more than one opinion and it’s our right as patients to obtain that input.

Seeking a second opinion can help you in the following situations:

1. Confirming a major diagnosis.

2. Obtaining another opinion about treatment for a medical condition.

3. Obtaining another opinion about treatment for a surgical condition.

4. Helping clarify an unclear medical or surgical situation.

5. If you are unhappy with the care given by a previous provider and want additional input.

6. If the advice given seems different from what you’ve read or been told by your physician.  (Always confirm online sources with your primary care physician before worrying too much and be sure you basing your opinion off of true medical sources such as WebMd or a medical association website).

Try to see the top consultant in your area. Sometimes this will be at a community hospital and sometimes at a big medical center. Your primary care physician can help guide you to who would be best given your situation.

So, if you are struggling with a medical situation and are feeling unsure about the path you are on, talk to your primary care physician about your concerns. It’s your health – so ask for what you need. Even a broken system can give you that.

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For concussions, Boston Bruin’s Patrice Bergeron’s story and his cautious, step-wise slow return to play when he returned to the ice in early 2009 the exact play book we need to follow when handling concussions in athletes of ages, and is consistent with current recommendations from the American Academy of Pediatrics as explained in the January 2009 Pediatrics (Volume 123, Number 1 pagers114-123).

Bergeron sustained his second concussion on December 20, 2008, the having occurred on October 27, 2007 after playing only ten games during that season. On January 4, 2009, two weeks post-injury, Boston Bruins General Manager Peter Chiarelli reported that Bergeron was starting light exercises because his symptoms were progressing well. Bergeron continued his slow, step-wise return to play until his return to the ice January 11, 2009 but was not cleared to play a game until January 27, 2009. His health was the driving factor; not playing in a game.

The currently accepted, step-wise return to play protocol involves starting with rest and progressing slowly as follows:

Step 1: No activity with rest.

Step 2: Light aerobic activity

Step 3: Sport-specific exercise

Step 4: Noncontact drills; progressive resistance training

Step 5: Full contact training after medical clearance

Step 6: Game play

Like with Bergeron, we have to be very cautious with concussions in young athletes and follow a similar plan. Returning to play too quickly and skipping steps can result in either catastrophic neurologic events resulting in permanent issues or death. In addition, we must recognize that one concussion increases the chance that more concussions will occur. We must recognize that the symptoms of a concussion are variable and can be as obvious as headache and loss of consciousness to as subtle as feeling “out of it” or being moody. We must be realistic that most athletes fail to report their own symptoms in order to keep playing, putting them in harm’s way. And, we must be willing to recognize when a player has had too many concussions to make some sports safe to play at all. This is where a medical team and neuropsychological testing can be very helpful.

Parents and coaches need to be educated on this step-approach to concussions, but so, too, do the athletes if we are to keep our teams truly safe. Everyone needs to be on board with how the system works and why youth sports teams need DL’s just like the pros. For the players, it is imperative that they understand that a concussion is a guaranteed, nonnegotiable spot on the DL. They each only have one lifetime brain; this is the only way to keep that brain safe and healthy during high risk sports.

Put another way, playing one more game in the setting of a concussion is like playing Russian roulette. So ask your self, is the risk really worth it?

(Originally posted March 2009; Updated December 2009)

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With childhood obesity becoming a national focus due to First Lady Obama’s Let’s Move campaign, many families are beginning to think about ways to help their children understand the many issues at play with health eating and staying in shape. One of our most powerful assets as parents is to use books aimed that not only educate our kids but due so in a fun and humorous way. For childhood obesity, Fat Tale, by librarian and puppeteer Karen Land, is one of the best.

What sets this book apart from many others on the market is that it is written for kids, it is simple, and it focuses not only on eating but on empowerment. This book has a happy ending and shows kids how easy it is to not only create a problem due to food but turn it around by being honest about the issues that created the weight gain. And, that working as a team with your family is the way to get to that happy ending.

The tale doesn’t use heavy handed tactics or guilt but simple, old-fashioned story telling. The premise is very simple: two kids meet a frog and realize the frog has a fondness for junk food. By helping this cute frog, Gorf, satisfy his habit, the kids, too, get hooked on the sugary treats. Soon, all three of the story’s protagonists find themselves overweight with a number of serious issues. Gorf can’t fit on his lily pad and dive. If he can’t dive, he won’t be able to hibernate for the winter, which is soon, and could die. The kids are finding the can’t fit into their clothes and have no energy at all to do anything athletic like they used to. They all turn to the grownups in their lives and forge a plan to shed the weight and not gain it back.

The ending was the best part of the story for me because there was no promise of a quick fix, just the realization that the path they were all on was not working. While very simplistic in many ways, the book accomplishes so many goals. It clearly shows what happens when you eat and not move. It clearly shows what happens to others if you encourage them to eat unhealthy. And, it shows by contrast what others are doing to help them be in more shape.

The book is billed for preschool through third grade but I’d push it a bit higher. While simplistic for a 4th or 5th grade for kids battling with obesity, sometimes simple is better and this book accomplishes that. Kids in school settings make more and more of their food choices independent of their parents as they progress through the grades. The earlier they learn to balance the pressures of the snacks and treats and eat an overall balanced diet, the healthier they will be. What kids need to learn is it is not the occasional treat that is the problem but the all the time treats. This book demonstrates this nicely by contrasting what the kids were doing with the grownup in their life, Jim, who only has the occasional treat.

Finally, one of the best attributes of the story is it is not preachy and actually puts the onus on the kids for a change. Regardless of who is offering the food, we have to recognize that the bottom line is the kids are the ones make the choices of what to eat and when and that they do have the control. Fat Tale helps show kids that without making them feel lousy about themselves.

All in all,  this book is a great addition to the landscape of nutrition books for kids and parents. This is a short tale with a huge morale, and very timely for the many kids right now who want to get to a healthier place but just don’t know how. This book can truly provide some inspiration to your family, if you are one of the many who are struggling with an overweight child but are just not sure how to begin a difficult conversation.

The book is also very affordable:

$8.20  at Author House   www.authorhouse.com
$12.99 at www.barnesandnoble.com or  www.amazon.com

My Final 2cents:  

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Can I have a cell phone? All my friends have one…We promise to be responsible!

Love, your daughters

A)

When my daughters both entered middle school, I quickly lost count how many times my husband and I were asked that question. It seemed to escalate quickly with each passing month! In the mind of a 12 year old, this was a very urgent and pressing matter – an actual tween crisis.

Our oldest daughter took an interesting approach in convincing us about her “need” for the cell phone. In addition to rattling off the typical reasons (safety, need, communication), she had her 8 1/2 year old sister poll her friends who had older siblings in middle school.  The results of this very unscientific poll were intriguing. Indeed, the vast majority of 6th graders and most of the 7th graders polled had a cell phone. In fact, a good amount of 5th graders also had cell phones.

Too much, too young? Read on.

I have to admit, this is not an issue where one answer fits every child and every family. So, you have to go into any “poll” with that mind set. But, there are some considerations that are worth noting that do come into play even for kids as young as 5th and 6th grade which I would not have been able to predict until my kids were at that age.

For example, I didn’t realize how unavailable true phones are in schools in general. If your child needs to reach you after school, grown ups disperse quickly in offices and without a cell phone, or a friend’s cell phone, our kids would have been unable to reach us.

Neighbors are not around after school for the walk home as they were when we were kids. So, if your kids is  a walker, that is another safety consideration.

Finally, pay phones simply do not exist. This is important for all our kids. If an emergency pops up and our kids are somewhere as a group or alone, a cell phone may be their only way to call for a ride or to call 911.

Where do experts stand on this issue? As I just mentioned, there truly is no agreed upon age for when a child is “old enough”. You have to consider your family’s life and your child’s after school life. That said, middle school, between 12-14, does seem to be when most kids get that first cell phone.

After talking to many friends, parents and colleagues, I’ve compiled a list of questions that you can run through with your family to help sort out if a cell phone is a reasonable addition to your child’s pocket:

1. Is your tween/teen home after school alone?
2. Does your tween/teen walk home from school alone or with friends?
3. Does your tween/teen often spend time away from home at overnight camp or at friends’ houses?
4. Does your tween/teen participate in activities where there is no handy phone  to call you in a pinch?
5. Is your teen/tween starting to attend parties, either at school or at friends’ houses?
6. Does your teen have a driver’s license or is starting to be in a car with older teenaged licensed-drivers?
7. Does your teen/tween ride on moving vehicles away from home, such as bikes, roller blades or skateboards?
8. Is your tween/teen starting to walk to the local pizza shop or store with friends to grab a snack?
9. Is your teen/tween starting to baby-sit?
10. Does your teen have a job?

Finally, once you make the decision to get a cell phone, that doesn’t end the story but actually begin it. Make sure you have a cell phone plan in place so your child understand the rules for proper use. Think about it – the phone costs money. How will your teen/tween contribute to the phone and the bills? What about abuse of the phone should your child make calls that are not urgent or emergent or necessary? What will the consequences be when that occurs (and you know it will!)? Make sure you spell that out clearly in a family meeting.

I’d suggest a payment plan of sorts and a contract that both you and your tween/teen sign. Since kids don’t have ways to earn money, perhaps have a list of chores your kids can do at home to contribute to the cell phone until they are old enough to babysit. It’s the principle you are emphasizing initially.

And, avoid phones with too many bells and whistles – they just tempt fate and drive up monthly costs.  Texting is very useful and if you can get a plan with a reasonable text plan, I think you’ll find it a great way to stay in touch with your family quickly but your kids don’t need internet access – not only is that pricey but it is hard to control on a cell phone.

By the way, you’ll notice that I refer to tweens and teens .  In my wildest dream, I really can’t come up with a reason why an elementary school child would need a cell phone. If you do, please let me know – really.  This is un-chartered territory so us parents need to learn from each other, and stick together!

(Originally posted June 2006; Updated February 2010)

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The issue, of course, is that health insurance is not even the tip of the iceberg. Without reforming the innards of the health care system and giving people a system that they can understand and use more easily, it matters very little whether people have insurance coverage.

At the same time, true reform is less about any system and more about how people address their own lives and health habits. Even in a broken system, there are many things we can all do to improve our overall health and minimize our need to see doctors, be on prescription and nonprescription medications, and need medical procedures.

If we all applied ourselves to spending more time on the areas that improve our health for the better — such as exercising more, losing weight, addressing health problems that put us on medications — we’d all be better off, and our health care system would actually start to be unloaded and cost less, even in its current form.

This doesn’t just apply to adults but kids, too. Kids deserve to enter their adult lives as healthy as possible, so be honest with them about their health issues — whatever they may be. Help kids overcome health issues today so they can be more healthy tomorrow. Believe me, if your kids are overweight or dealing with some other medical issue, they know it and want help addressing it.

With the new year upon us, this is the perfect time to examine the habits we have that maximize good health and be realistic about the habits we have that put our good health at risk. For example, ask yourselves:

- What do I do for exercise?

- What do I eat and drink drink each day? (Keeping a log for a week can be very eye-opening!)

- How many packs of cigarettes do I smoke per week — or day? (If “none,” congratulations!)

- Do I have health problems I need to address?

- Am I on medications I’d like to be off of?

- When was the last time I went to the doctor for a general physical?

Sit down as a family and answer these questions together. Then work together on the issues that you all have in common and help each other with the issues unique to each person. By the end of 2010, you’ll all be more fit and will have kicked some habits you’ve needed to for a long time.

You deserve to live a healthy life, and that type of reform can’t be found in any health care law but starts with you and the changes you make in your life.

In fact, those are the only health care reform changes that really matter in the long run to you and your family, so start reforming today.

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My daughter is 3 ½ years old. I just spent the last year raising her alone while my husband was in Korea. Since we are a military family, our lives change every so often when it has to. Lately our daughter takes up to 3 hours to go to sleep, we have left her by herself and we have to take her back into her room at least 6 times. We’ve tried reading stories in her bed and staying in her room until she falls asleep. On occasion, she has lain in our bed for hours before falling asleep.

During the evening struggles, she often throws fits and kicks and screams. I need help!!! This is affecting my marriage and now I have become one of those mothers that I didn’t want to become with a spoiled child. Please help!!!

Thank you,
Rebecca

A)
Dear Rebecca:

Please know you are not alone in your frustration – we’ve all been there with toddler struggles but you have the additional burden of having a husband who is only intermittently in the picture due to his military obligations. This is not small challenge for so many families today.

Toddlers become easily disrupted when their schedule and sense of security change, and in today’s world deployment of a parent is one of the biggest stressors facing families and kids.

Deployment and separation are very difficult on a family and it is not uncommon for couples and kids to feel enormous stress even on the welcome and happy occassion of a home coming.
The military often has excellent family services which I’d encourage you to explore since part of this situation is an adjustment for all of you to your husband’s tour of duty and his return. I found some very useful resources online that may help you at least start to understand your child’s view of her Daddy’s comings and goings. She is old enough that she may also have some fears about his job. Here are some links that may help you out:

Militarybaby.com: helping a preschooler when daddy is deployed.

Talking to my friends whose husbands have been in the Armed Services, I learned that there are many services available to military families. From what I understand, all military families are connected to a FRG – family readiness group. Those groups form the foundation for support groups, play groups, etc. That group would be a good starting point for you. There really is power in knowing you are not alone.

You could also talk to your husband’s command’s wife who is often in charge of help out the spouses. My friends who have had husbands in the army tell me that different units have different levels of cohesiveness but all these services do exist in one form or another. Finally, keep in mind that all posts have medical units with therapist. From what you described, I’d start there while you are pulling together more social supports.

In the mean time, you and your husband should try and be consistent with your daughter and present a united front. She may be toying with limits now that two parents are actively involved. While I understand how frustrating it must be for your husband to have to deal with a child so out of control, help him see this through her eyes and he may feel less helpless. He’s likely feeling a bit guilty and that is not an easy feeling. This will get better but will take a bit of work from all of you, a great deal of patience and understanding, and some support and help from the outside.

Dr. Gwenn

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The vast majority of schools in Massachusetts have fairly strict guidelines for outdoor activities that our children are expected to follow at school. Use this to your advantage and expect them to follow these rules all the time, even at home or when walking to school. So, if the children are expected to wear certain clothing at school before being allowed outside, require the same at home or on the slopes. And, if its too cold for outdoor recess, than its likely too cold to build a snowman in the backyard!

Keep in mind that not all accidents are many variables are out of our control. At the same time, paying attention to the areas we can control will not only reduce the chance of preventable injury but maximize your family’s fun.

1. For sports requiring special equipment, be sure the equipment is well made and fits your child properly. Many outdoor stores do carry a full line of equipment, including used equipment, and can help you outfit your child properly. You may also want to check out the Consumer Product Safety Commission web site (www.cpsc.gov) to be sure any equipment you are considering has not been recalled.
2. For any winter sport, including sledding, your children should wear a good ski helmet. We only have one brain and it is not as easy to fix as a broken arm. So, if your child won’t wear the helmet, don’t let him participate – the risk of injury is too high otherwise!
3. Don’t forget eye protection – not only from the snow or ice but the sun. Good eye goggles or sunglasses are crucial for winter sports safety and will minimize the risk of injury should your child fall in the snow or be hit with some snow/ice.
4. Keep an eye on the local weather and don’t underestimate the danger that extreme cold can cause. The windchill is the number to pay attention to – that is how cold it feels outside due to the blowing, arctic wind. The more below zero it feels, the faster the wind is blowing, the more dangerous it is to be outside.
5. Avoid the tempation to leave small children in a parked car for even a few minutes when it is very cold – it only takes 5 minutes of extreme cold to cause hypothermia or frostbite. Better to take your children with you than to leave them in a car unattended – even for a few minutes.
6. Dress your child in layers underneath the snow suit to lock in the heat. Thermal clothing is the best but medium weight cotton clothing will work fine as well. Long underwear, turtlenecks and thermal socks are all essential for most outdoor winter sports. If your child gets too warm, she can always remove a layer.
7. Finally, don’t forget the hat – most of our heat is lost from our heads so keep them covered!

Here’s to a fun and safe winter.

(Originally posted November 2003; Updated December 2009)

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