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A child’s emotional health is just as important as their physical health. We as parents expect the terrible twos and know that tweens/teens can be erratic and moody. But how are you to know if its more than just being a teenager? Read on for some great tips and advice from my guest blog post by Sean Paul, MD.
As a parent, there aren’t many things more distressing than worrying about your child’s happiness. As a child psychiatrist, I can provide some useful insights that parents and family members can use to identify early signs of depression in a child or teen.
What most people don’t know is that depression is common in children and teens, and is often not recognized and treated. Studies suggest that up to 8% of children 12-18 years old have major depression1!
Early Signs of Depression Include:
1) Depressed Mood: This is a general term for feeling sad, down, or low most of the time. In children, however, this can look a bit different and present more like irritability. This is because children aren’t as good at identifying and organizing their emotions.
2) Losing pleasure in things: Children with depression can find things they used to enjoy to now be “boring” or “stupid”. This can include activities, friends, or other things they used to enjoy.
3) Weight change: Some children with depression gain or lose weight. In some cases, it’s a lack of the weight gain they should have had as they grow that is a sign.
4) Sleep problems: Any sleep issues can be a sign of depression. This includes having a hard time falling or staying asleep, waking up in the night, waking too early, or sleeping way more than they used to.
5) Restlessness: If a child is suddenly pacing around, pulling on their clothes all the time, wringing their hands, or other fidgeting, that can be a sign of depression.
6) Loss of energy: Medical causes should be ruled out, but otherwise being tired and unmotivated can be a sign of depression.
7) Feelings of guilt or being worthless: The child may be overly disappointed in themselves over small things, negative about their activities or school or self-image.
8) Trouble concentrating: Problems paying attention and concentrating can be a sign of depression.
Other concerning signs:
1) Thoughts or plans of death or suicide
2) Hearing or seeing things that are not there (hallucinations)
If you have any concerns that your child may be depressed, talk to their doctor right away so that they can help, or refer you to someone who can! It is always better to be overly cautious when it comes to depression, rather than to miss the signs or dismiss them as no big deal.
Sean Paul, MD Child and Adolescent Psychiatrist and Founder at NowPsych.com
1) Mental health surveillance among children--United States, 2005-2011. Perou R, Bitsko RH, Blumberg SJ, Pastor P, Ghandour RM, Gfroerer JC, Hedden SL, Crosby AE, Visser SN, Schieve LA, Parks SE, Hall JE, Brody D, Simile CM, Thompson WW, Baio J, Avenevoli S, Kogan MD, Huang LN, Centers for Disease Control and Prevention (CDC) MMWR Suppl. 2013;62(2):1 .
“Should I give my child a multi vitamin?” This is one of the most common questions I get asked from moms. It’s often at a well child visit, wanting to know how to improve picky eating or also it comes up at sick visits when a child gets numerous colds and coughs and parents like you may feel their child is sick “all the time” and want to know how to “boost their immune systems” to prevent them from missing school.
As a pediatrician, kids health and well being is of utmost importance to me. Why? Not only do I want to keep children safe and care for them if they get common childhood conditions like ear infections, strep throat, eczema, and broken bones but I also want to teach parents (and kids) what they can do to control their health now and to drastically improve wellness as they got older by preventing obesity, diabetes, heart disease and so much more. A big portion of this is by instilling habits of good nutrition and healthy lifestyle choices.
Are vitamins a quick fix for most healthy kids? The short answers is no. If your child is eating a variety of foods and is not on a restricted diet, then extra vitamin supplementation is not needed. Can they hurt? A one a day multi vitamin for extra insurance won’t do harm (except the expense) but mega dosing on vitamins particularly fats soluble vitamins like ADEK that can build up in the body can cause toxicity. So more is definitely not always better. In addition, giving a vitamin supplement is not an assurance or a pass for your child to then eat unhealthy processed snacks and fast food. The biggest issues and concerns with the average kid’s diet is NOT the lack of vitamins (as even sugary cereals are fortified with vitamins) but that a typical western diet is low in fiber, fruits and vegetables and high in added sugar and unhealthy fats.
That said, here are 3 nutrients to know about that are often lacking and could use a boost in many children’s diet.
Iron – This is one of the most common deficiencies in kids of all ages particularly preemies, breast fed babies, toddlers who drink a lot of milk, growing teens and girls who menstruate. Low iron can affect neurological development. It can lead to iron deficiency anemia (a low blood hemoglobin level) this can cause a child to be pale, low energy, tired, headache and fatigue. There are many sources of foods rich in iron. Heme iron is a great source which is found in meats, turkey, chicken, liver, eggs and fish. There is also non-heme iron that’s is plant based in foods such as dark green leafy vegetables, legumes, seeds, and dried fruits. Here’s an important tip, non heme iron will be absorbed better if eaten at the same time as some vitamin C. So serve together beans with sliced tomatoes, or even broccoli and bell peppers to dip in hummus.
Vitamin D - This is a fat soluble vitamin that is needed for bone growth and development and to prevent a disease called Rickets. You may be aware that the body can make vitamin D, however sunlight is needed so depending on where you live, the amount of sun exposure, the season and even how much sunscreen your child wears they probably still need to ingest some sources of Vitamin D. Breastfed babies need additional Vitamin D as it is not as readily absorbed from breastmilk If you have questions or concerns speak with your pediatrician. For older children food sources of vitamin D include fish such as salmon, beef, liver and eggs as well as fortified foods such as many dairy products including milk and yogurt , non-dairy milk (soy, almond) and many cereals are fortified too.
Calcium – This is a mineral also important for strong bones and teeth as well as for functioning of muscles heart and the nervous system. Dairy products (cheese, yogurt and milk) as well as non-dairy milks are very good sources of calcium. Tip- when serving fortified nondairy milks, make sure to shake well as the calcium needs to be dispersed throughout before pouring otherwise it settles at the bottom of the container. Other no dairy sources include seafood, dark green leafy vegetables, tofu, legumes, almonds and dried fruit. Lastly many cereals and breads are fortified with calcium as well.
Looking at your child’s overall diet for the week rather than just each day may be a better way to assess what they are eating and the nutrient value. A food diary for a week often can help clarify and you may be pleasantly surprised that with added nutritious snacks, your child may be meeting their nutritional requirements. Reach out to your pediatrician if you still have concerns about your child’s overall diet. They can evaluate and determine with you if added supplementation is needed.
Tips on Healthy Snacking for Kids
Parents often ask me about snacks for their children once they are eating table food. Should they even give them snacks? If so, what kinds are good for them, and how often? In general, after age one I recommend 3 kids size meals and 1-2 snacks to help the get their daily nutritional requirements. Try not to stress or obsess at each feeding about them eating all that you serve. Your job is to provide the food, your child’s is to decide how much to eat. Instead look at the nutrition content your child eats for the week rather than just on a daily basis. Here are some more tips to get the most health benefit out of your child’s snacks.
Cut out the juice and instead serve whole fruit- Juice is high in concentrated sugar, low in fiber, as well as causes big fluctuations in glucose and insulin levels. Making whole fruit more accessible by cutting it up and even leaving it in containers or grab and go bags will increase the likelihood it will be gobbled up. A little fruit and veggie preparation for the week can make a huge difference in the amount eaten. Some suggestions: melon balls, tangerine slices, a fruit kebab skewer, even a glass of berries with a dollop of yogurt on top. Eating the whole foods instead of juicing will ensure your child feels full and satisfied until it’s time for the next meal.
Snacking is an activity. Be mindful, present and enjoy your snack completely. Don’t snack on the go or even in front of the television. This type of mindless/distracted eating often results in excess processed junk foods high in fat and sugar, low in fiber and important nutrients. In addition, studies show eating while watching tv results in consuming more empty calories and still feeling hungry. I suggest, if you are having a snack, savor it by chewing slowly, paying attention, sitting at table and if possible don’t multitask.
Think outside the conventional snack bag I tell parents to think of a snack as a small meal. A snack is just another way to get the added fruits/veggies and nutrients kids need. So instead of assuming ‘snack’ means a bag of chips or chocolate bar, you can serve hard boiled eggs, peanut butter and crackers, turkey rolled up, waffle with fruit spread, a simple homemade mix of whole grain cereal, nuts, craisins and dark choc chips. In addition, kids love to “dip” using dressing, salsa, hummus or yogurt with their sliced raw peppers, carrots and cucumbers. If in a rush, and no time to spare, a glass of milk can be a snack too, Milk is high in protein, calcium, vitamin D as well as potassium and B vitamins.
Don’t confuse boredom for hunger. Often kids say they are hungry when in reality they are bored or don’t know what to do or play. If you child just ate and is whining to eat again, offer some water and then try to coax them in to an activity. Surprisingly, if you initiate play with them for a few minutes, for example coloring, or building blocks, they will become engaged and you can fade yourself out as they continue to play independently. By not over snacking and eating out of boredom, your child will have a healthy appetite at the next mealtime.
Daily snacks are different than “desserts’. A dessert or treat is usually thought of as an after meal food that may not be so healthy or nutritious. Desserts/ treats are inevitable and my advice, it’s totally ok to indulge on an intermittent basis. I tell my patients that total avoidance of cakes, cookies, and ice cream is not necessary, in fact I see it backfire all the time. Children who never eat any kind of junk food or a less than healthy treat often overindulge whenever the opportunity arises. So instead, embrace the moment and allow your child to enjoy the dessert. I also advise against labeling foods good or bad. Indulge in the birthday cake on occasion and savor the deliciousness. But just remember portion size is key and you can control that amount (rarely are seconds necessary) when serving to the family . In addition if most of the time, you eat healthfully, provide a wide variety of high nutrient snacks, then your child overtime will develop a healthy relationship with food.
Happy snacking! What are your child;s favorite snacks? Let me know:)
Friendships and socializing with other children sometimes comes naturally but often the are bumps in the road even with the most caring and loving child. Check out this guest blog with great tips for new parents to learn the art of helping your toddler make friends.
Helping your Toddler Make Friends
Parents often worry that their toddler is too timid to make friends and every effort to help them socialize seems to backfire. Socialization is an important milestone in your child’s life but some kids take time to make friends. Toddlers want to reach out to other children but like adults, they have fears and insecurities wondering if the other child will steal their toy or refuse to play with them. Don’t let your anxiety get the better of you; instead, work out ways to help your child hone their social skills.
7 ways to help your toddler make friends
1. Take it slow
You were the first person your child interacted with, so although he is now interested in the world around him, he still turns to you for security and comfort. Separation anxiety in toddlers generally peaks at 12 to 18 months so if your child seems a little extra clingy during this period, don’t admonish him for it, instead help him overcome his fears at a slow and steady pace. A simple way to do this is to let him make friends with just one child at a time so that he does not feel overwhelmed.
2. Encourage your child to parallel play
If your child is a little shy, don’t force him to interact with other children. A simple way to coax him out of his shell is to encourage him to parallel play – where he can play by himself while sitting next to another toddler who is also playing by himself. Parallel play is the first step of socialization as your child will soon move from parallel play to parallel-aware play, where they acknowledge each other with a tentative smile.
3. Be an “emotion coach."
It’s natural for children to experience negative emotions so teaching your toddler to control these responses will go a long way in helping them socialize with other children. Don’t dismiss their negative emotions but instead talk to them to understand what they are feeling so that you can help solve the problem. A recent study found that children are better at regulating their emotions and developing friendships when their mothers used emotion socialization strategies.
4. Get involved in playtime
You dread the thought of turning into a helicopter parent and so you try to fade into the background and allow your toddler to learn on his own. However, this will probably bring your child’s insecurities and fears to the surface and they may feel abandoned. Instead of adopting a ‘sink or swim’ attitude, you can arrange a playdate where both the mums get involved in playtime. Play with the other child as well so that your toddler can follow your example and learn to make friends easily.
5. Don’t force your child to share
“Give your truck to Michael, you need to share it… play with another toy” – if this sounds like something you would normally say to your toddler, you might be doing more harm than good. Forcing your child to share can have the opposite impact on your child’s sharing skills as they instinctively feel that their ownership is being challenged. Instead, of forcing your child to share, teach your child to take turns with playing with a toy. Never snatch a toy from your child and give it to his new friend as you’re modelling grabbing which will make your child more possessive.
6. Time your toddler’s playdates
Whether it’s music, baking, standup comedy or setting up a playdate, timing is everything! The most important thing is to decide a start time and end time to the playdate. When scheduling, choose a time when your child is least likely to be tired or cranky – generally, this is the morning. Limit the playdate to 45 minutes to an hour as your child will probably get tired or fussy if playtime lasts for over an hour. It is better to keep first interactions brief and only once your child is comfortable with his new friend, you can extend the playdate to over an hour.
7. Teach your child empathy
Empathy is the ability to understand and share another person’s feelings and feeling another child’s pain would be unpleasant so obviously your child’s instinct would be to avoid it. Parenting experts at Whattoexpect.com recommend that you talk to your child about these feelings and help to bolster his self-regulation skills so that he feels secure which will allow him to overcome this reaction. Encourage your child to understand what his friend is feeling so that he can understand his actions. For example, if your son grabs his friend’s toy, don’t try to take it away from him immediately, instead, explain that his friend is sad because your son took away his toy. Always follow-up with what your son can do to solve the problem – in this case, you can tell him that his friend will be happy once he gives the toy back.
Some toddlers take time to develop social skills so learn to be patient with your child and understand that all of this is new to him. Don’t force him to interact with others but instead gently encourage him to make friends. There will be small squabbles along the way – be prepared for that and help to handle it and learn from it. Aggression in toddlers is a common problem and arises out of fears and insecurities so the best way to prevent such problems is to foster a strong sense of security so that he knows you will always be there for him.
Heart Health in Kids
I was inspired to write this as February is American Heart Month to remind everyone that heart health really starts in childhood to avoid cardiovascular disease, hypertension, obesity and diabetes. Kids today have developed so many bad health habits that they are facing heart attacks in their 30s. Many experts predict they will be the first generation to have a lower life expectancy than their parents. But it doesn’t need to be this way. Parents like you have a great influence over your kid’s habits. By modeling the behaviors as well as instilling positive habits, you can make a huge different in your child’s health. It’s all about establishing good habits and breaking the bad ones early on. Our habits from childhood continue into our adult lives and can have a huge impact on our overall health more so than just our genetics. So let’s not wait, here are some tips to improve heart health as well as avoid other chronic diseases.
Move it- Daily exercise is a must. For kids at least an hour a day of heart pumping movement. Childhood is a great time to try out different activities and sports, whether team or solo to find a good fit. For kids rotating activities and sports is preferable to avoid over use injuries in growing bones, joints ligaments and muscles. The idea is those kids that are active in childhood will continue to seek out physical fitness as adults. I was into dance and gymnastics as a child but now bicycling, and pilates are more my speed. It doesn’t really matter what activity you do, as long as you get your muscles fired up, strengthening, improving balance and get your heart rate up -to help combat chronic diseases like osteoporosis, heart disease and improve mood. Remember family activities like walking the dog, raking leaves, and free play at the playground all count too!
More Plants – Eating a diet that is predominately plant based (fruits, veggies, whole grains) and less emphasis on protein from meat is a great way to keep healthy . It provides loads of vitamins, minerals, antioxidants as well as lots of fiber to keep you full and regulate your sugar levels. Parents are always concerned about kids getting enough protein but in general, kids get more than even necessary on a daily basis whether it be meat, eggs, dairy, poultry, fish) Opt for smaller portions and instead pile on the fruits and veggies. Make those side dishes the main event! In addition limit cured, smoked and fried foods and opt for kids getting used to steamed, baked and sautéed foods.
Ditch Desserts- A common error with kids is too start a habit that a meal ends with dessert. Forget the sweets after dinner, you should end feeling adequate and full from the food on your plate. If hungry a few hours later, first drink a glass of water or even milk. If need be give a snack that’s healthy and avoid the highly processed, sugary laden snacks. Save those for more special occasions rather than daily treats. Another tip is portion control. I have an ice cream loving family so trade off between frozen fruit treats and ice cream and in addition portion control is key to feeling satisfied and avoiding binge eating from deprivation. Serve a small single cupful of ice cream rather than ordering a large 2-3 scoops. Your kids will still be happy😊
Chat with Your Child- Though it may seem like your kid tunes you out or doesn’t want to hear what you have to say, start early and keep talking about dangers and risky behaviors of smoking. Kids who’s parents talk about drugs and alcohol are 42 percent less likely to use substances than those whose parents don’t. And I know as a pediatrician its not enough to just ask about cigarette use, you must discuss E-cigarettes which now are all the rage and extremely addictive. The most common brand is JUUL that comes in enticing fruity flavors, and each one pod contains as much nicotine as a full pack of cigarettes! I am seeing teens who are using and can’t stop- they quickly become jittery, develop headaches, anxiety and nervousness, diarrhea and difficulty concentrating. The other chemical carcinogens as well as nicotine are dangerous to the developing brain long term. And it appears those kids that start off with e-cigarette use “just for fun” end up using regular tobacco cigarettes at a much higher rate than kids who do not vape. Let your kids learn the facts from you and help them stay healthy now and avoid heart disease and lung cancer later on.
Preventive Care Visits- Show your kids you care about their health and your own. Make sure to schedule family annual physical exams with your physicians and stay up to date on immunizations, routine lab tests and physical examinations to ensure your health is on track. Prevention is key to avoiding chronic disease. Its also a great time to get specific advice from your doctor if you have a concern or there is a family history of a certain disease. Partnering with your family doctor or pediatrician, asking questions and being a role model will help your kids stay connected to the health system as they become young adults and in charge of their health. Remember starting them down the right path with good health habits can make all the difference now and into their future.
Motrin vs Tylenol: The Great Debate for Treating Fever in KIds
As a pediatrician, I am asked on a daily basis from worried parents about what they should give their child with a fever, Motrin (Ibuprofen) or Tylenol (acetaminophen) to bring down the temperature.
This question always requires more than a one word response to the choice between antifever medications . An explanation about if medication is even necessary for the fever and to clarify many long standing fever phobia misconceptions. Mainly, it is not necessary to treat the number on the thermometer, nor is it always necessary to bring the temperature down.
What is important is to address how the child is feeling and behaving regardless of their temperature. Are they happy, playful drinking fluids or are they cranky, irritable and uncomfortable? If the former then no fever reducing medicine is even necessary. What pediatricians want parents to know is to not be scared of fever, it’s the body ‘s way of fighting off the infection. The goal of a fever reducer is to make a kid feel better so they can rest and recover. The over the counter medicine does treat the illness nor make them better or less contagious any faster. The take home message is to use fever reducers for added comfort not just because your child has an elevated temperature documented on the thermometer.
Now that you have come to the decision that a fever reducer is warranted, here is some information on helping you decide which one to use Motrin or Tylenol.
Efficacy and Safety - Both Tylenol and Motrin are effective in bringing fever down in otherwise healthy kids over the age of 6 months. From my longstanding experience with patients, the fever does tend to decrease faster and remain lower a bit longer with Motrin than with Tylenol. But choosing which to give when your child is sick often comes down to what you have on hand in your kitchen or bathroom cabinet when your child needs it. Always use the measuring device that comes with the bottle or a measuring spoon or syringe. A kitchen spoon is not an accurate measure and can lead to under or even overdosing.
Length of Action- Tylenol can be given at 4 hour intervals as needed where as Motrin is every 6 hours. As a parent, it’s nice to have less dosages to administer, especially if it’s a struggle because your child does not like to take medicine in the first place. An all to common practice in my opinion is alternating Tyenol and Motrin. Parents often do this to keep the fever “down” or suppressed. In most cases this is not needed especially if you remember treatment is for comfort and not trying to get the thermometer to read 98.6F. In addition alternating medication every 3-4 hours leads often to medication errors and overdoses which can potentially be severe. So if you are giving both,( a practice I rarely recommend) please make sure to write down which medicine, the dosage and what time it was given, so all caregivers are aware to avoid errors.
Dosing is Key- Regardless of whether you are giving Ibuprofen (Motrin) or acetaminophen (Tylenol), make sure you know the correct dosage for your child. Dosage is always based on their weight NOT on their age. This will help to ensure the medication works as weight is much more accurate than a child’s age (so keep their weight from their last check up visit handy). A common mistake I hear when a parent tells me that a fever reducer “didn’t work” is not giving the full recommended dosage. Often parents are scared of over medicating so they give a reduced or lesser amount than indicated and then are surprised it didn’t help the symptoms adequately. Tip, if you are going to give a medication always give the correct full dosage each time.
Pros and Cons - Tylenol can be administered to infants under 6 months of age. It does not cause stomach upset and can be used for pain or for fever reducing and lasts about 4 hours. An added perk about acetaminophen is that it also comes in suppository form if your child is vomiting or refusing to take anything by mouth, often this is the easiest route to deliver the medicine in a sick infant/toddler. The downside to Tylenol it can cause liver toxicity if given in excess or accidental overdose, so give as directed and keep it stored high up and out of range when not in use.
Motrin is also great for fever reduction but has added benefit for reducing inflammation likes sports and muscle injuries. It keeps fever down longer and the dosing is less often at every 6-8 hours as needed. Remember Ibuprofen is for children over the age of 6 months of age, it may cause more stomach upset so avoid if your child is vomiting or not eating.
Lastly which fever reducer to give may ultimately come down to your child’s preference. Neither fever reducer will be helpful if they just won’t take it. Because both are safe and effective when taken correctly, opt for the one your child will take without a major meltdown or tantrum. This may be based on its flavor, consistency or even form ( liquid vs chewable) And remember lots of extra TLC , added fluids to drink to avoid dehydration and even a tepid bath or cool compress on their forehead for added comfort and relief.