Is Screen Time Hurting Your Child's Eyes?-Simple Tips to Avoid Eye Strain From A Pediatrician

Do you remember when your mom or grandma told you not to sit so close to the TV set or you could become cross-eyed, or even worse, go blind from watching too much television? Well, guess what? That wasn’t entirely true but they were on to something. Myopia or nearsightedness (meaning a child has difficulty seeing objects in the distance) has nearly doubled to 42% over the last 50 years. A study in Ophthalmology provides evidence that the increase is partly to do with close-up activities involving using screens, but also due to traditional reading books.

Myopia or nearsightedness (meaning a child has difficulty seeing objects in the distance) has nearly doubled to 42% over the last 50 years.

This makes sense considering how much time kids spend behind screens today. As a pediatrician and a mom for over two decades, I have witnessed the daily use of digital devices for children of all ages increase exponentially — from watching movies and TV shows — to playing games, chatting, and even as an educational tool in schools. And parents increasingly use digital devices to keep their children quiet when out to dinner, to soothe when upset, and sometimes as a reward for good behavior. In short, screen time is ubiquitous, portable, and easily accessible at home, at school and while on the go.

Much more research needs to be done in this area about why nearsightedness is on the rise but spending more time in nature playing outdoors, particularly for young children, can actually slow the progression of nearsightedness — just another reason to put down the digital devices and get active. Currently, what we do know for sure is that using computers, phones and tablets can cause digital eye strain, even in kids.

…spending more time in nature playing outdoors, particularly for young children, can actually slow the progression of nearsightedness.

What is digital eye strain?

Digital eye strain is a condition that arises from too much up-close eye use. Your child may complain of blurry vision, dry eyes, or a burning sensation. These symptoms can occur with intense focusing and repeated scrolling on a device which makes the eyes dry out from decreased blinking. In addition, overuse can lead to headaches, neck pain, and stress. I even see kids who get nauseous and dizzy from too much screen time. The symptoms can be daily, persistent and painful.

The good news is there are some pretty simple solutions. Here are the tips I give to kids and parents to help avoid eye strain and promote good eye health.

Dr. Jen’s 10 tips to prevent eye strain in kids:

1.     Follow the 20–20–20 rule. Make sure your child takes screen time breaks at least every 20 minutes. Stop, look up and out at an object 20 feet away for at least 20 seconds. This will rest your eyes, increase blinking and decrease eye strain. In any case, remind your child to blink if they have been on a device for an extended period of time.

2.   Avoid using digital devices in bright light or outside. Glare can also cause eye strain.

3.    Monitor and limit total daily screen time. The easiest way to do this is to use a parental control app. I like Qustodio.

4.   Put away devices during meals and power off devices at least an hour before bed time.

5.    The American Academy of Pediatrics recommends no screens before age 18 months as education and learning is better developed through creative, hands-on physical play, and interacting with caregivers. For toddlers, watch screens together, and limit to about one hour a day of high quality programming.

6.   If the air in your home is very dry, consider using a cool mist humidifier in the room which will keep mucus membranes like eyes, nose, and mouth from feeling dry.

7.    Prioritize outdoor play whenever possible. Walk the dog, play catch, watch the clouds go by.

8.   Read books in paper form instead of digital format.

9.   Make sure that digital media does not take the place of getting adequate sleep, exercise, nutrition, and quality family time.

10.  And last but not least, make sure to have children keep handheld devices between 18–24 inches away (45–60 cm) rather than right under their noses. See, Mom was right. :)

repost from Qustodio- digital safety and wellbeing for parents, where I am a brand ambassador / parenting and pediatric expert.

Does your child complain of eye problems when using digital devices? Leave me a comment below and let me know if any of these tips helped your family with their daily media diets.

Does Your Child Need a Daily Vitamin? Advice from a Pediatrician/Mom -Dr.Jen

“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.

“In most cases a daily vitamin for kids is not necessary, instead focus on healthy foods most of the time.” Dr. Jen

“In most cases a daily vitamin for kids is not necessary, instead focus on healthy foods most of the time.” Dr. Jen

Motrin or Tylenol: The Great Debate for Treating Fever in Kids

                            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.

Fever reducer tips by Dr. Jen

Fever reducer tips by Dr. Jen

 

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.

 

Best Toys for Tots This Holiday Season

Best Toys for Tots This Holiday Season

Holiday time is here and there is increasing advertisements and marketing directed at parents and children about what are the best toys and must haves this season. In addition, your kids will be asking and pleading for the latest or most updated tech games or apps that their friends have or want as well.  There is also is a lot of pressure and guilt around this time of year to make you feel the more you spend on gifts and toys, the happier your child will be. As a pediatrician and mom, I am hear to tell you differently.

Toys are really a tool, that can be used to help bring meaningful interactions between you and your child that can foster language skills, motor skills and social-emotional development.  These are very important aspects of play, more so than one gets from electronic, battery operated toys and so called “educational apps” for babies. Most of these claims are unsubstantiated, with little or no scientific evidence, particular in young infants, and may be potentially harmful if used in excess.

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Here are some tips for choosing toys for your little ones

1.       Think old school.  Remember when you were young, you had the animal farm, or doll house that didn’t have a working doorbell or a battery operated cow that said moo. You had to act it out yourself.  This pretend play helps with creativity and imagination instead of quick reinforcement from electric generated sounds.

 

2.       Books are always beneficial. Whether you are reading to your child or they are at an age they can start reading simple books, this activity not only helps with language and vocabulary but also a great way to bond with your child.

 

 

3.       Spark the imagination and creativity. Manipulatives like blocks, legos, playdoh, markers, and  age appropriate crafts can grow with your child as their skills progress.  Also pretend play with kitchen sets, trucks, and cars can help kids simulate actions they see around them.

 

4.       Bored? Try a Board game. Board games are great for turn taking, following directions, and social interactions. Again, I prefer to look for non- electronic versions.  This way you don’t have to worry about replacing batteries or even the real dangers of accidental ingestion of batteries.

 

5.       Be active- Kids should not be sitting still most of the day. They don’t necessarily need organized sports at a young age, but they should be moving.  Various size balls, ride on toys, pull toys, all keep kids exercising and stretching during playtime.

 

 

6.       Less is more. Kids get so overwhelmed when they have too many toys to play with or to choose from. I suggest rotating toys that are in view every few weeks so an old action figure may seem novel again and a puzzle will seem exciting if they haven’t put it together for some time.

7.       Be mindful of screen time.  Earlier is not better when it comes to electronic media exposure. Don’t get sucked in to the hype about early infant learning with 2 dimensional screens. Babies need positive parenting and caregiver interactions to foster important brain connections for optimal learning.   So limit screen time (video/ computers games/ phone apps) to less than an hour for children 2 years or older.  Children younger than 5 years old (toddlers and preschoolers)  make sure its developmentally appropriate and preferable with adult supervision.

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12 Tips For a Fun Safe and Somewhat Healthy Halloween

Halloween is definitely a favorite holiday for kids. Children love getting dressed up in costumes, socializing with friends, trick or treating and yes, some candy too. As a pediatrician, I have seen my fair share of stomachaches, injuries and avoidable injuries. Here are some of my  top safety tips as well as some healthy  tips that I promise won’t put a damper on the festivities.

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1.     Make sure costumes fit properly. When sleeves are loose and flowing or pants drag on the floor, they are more like to get snagged or caught on objects leading to falls, scraped knees and even broken bones. Other items like long untied belts or high heeled shoes can be hazardous too. Be sure face masks fit properly, especially the eye and nose openings so as not to obscure vision or breathing.

2        Keep costumes brightly colored or use reflective tape.  Bold color or placing reflective tape on your child clothing or even trick or treat bag is important especially if outside in areas that are not well lit. This will make it easier for them to be seen particularly by drivers in cars.

3        Patch test all makeup before using. Kids love face painting, but many of the makeup kits for Halloween don’t use high quality ingredients and may have chemicals that react on skin causing rashes like hives, bumps, redness and itching. Be sure to test on a small area of arm before applying to face.

4        Avoid imported inexpensive costume jewelry for young children. Please be wary and if purchasing please supervise if your young child is wearing accessories that have small parts that can potentially break off causing choking ,be put up their nose or in their ears. In addition young children may put these accessories in their mouth to chew on, causing the paint to come off and be swallowed.  Imported painted costume jewelry items have been known to contain metals like lead and cadmium which are toxic if ingested so if you have a little teether avoid altogether.

5        Do not buy decorative contact lenses. Non prescription contacts can give you the appearance of bright colored eyes( magenta , neon green or Dracula eyes) however because they are not fitted properly, there is potential for severe damage to eyes such as corneal scratches, infections and in some cases even visual loss. It is not worth the risks.

6        Darkness can mean more dangers outside. Supervision is needed by adults or even responsible teenagers while out and about going house to house. It’s a great idea to have a designated route ahead of time. In addition carry flashlights as many neighborhoods may not have sidewalks or even street lamps.  I encourage all homeowners on Halloween to keep their outdoor house lights on as well as to make sure walkways are clear of wet slippery leaves to make the whole neighborhood brighter and safer.

7        Avoid candles in Jack-O -Lanterns.  Kids move fast and not always paying attention to their surroundings. Candles can cause burns and unexpected fires, so instead use a battery operated flameless light or even a flashlight to illuminate your pumpkins.

8        Restrain pets or keep in another room when trick or treaters come to the door. Even the most docile and friendly dogs can get over excited by all the kids and crowds. Children who fear animals may cry or be frightened, others may try petting the tail or animals face causing an unexpected reaction or even get bitten. To avoid any problems keep your pets away from the front door.

9        Eat a good meal before going out trick or treating. Starting out on a full stomach can help discourage kids from wanting to eat the candy and goodies throughout the night and it will help to cut down on binge/ overeating. Yes Halloween stomachaches are a real thing.

10   Walk to the farthest point you are traveling and then trick or treat on the way back home. By doing this, you and your kids are getting a bit more exercise and physical activity, because eventually you have to walk all the way back home.

11   Sort and inspect candy before eating. Even though it is rare for tampering of candy on Halloween, especially if you stick to neigbors that you know, its important to check the candy and home baked goodies, as well as remove any items that may be potential allergens to your child.

12   Share Share Share. Most kids have so much fun on Halloween, but it’s a great time to remind them that not all children may be able to participate in the holiday events. Let your child pick out their favorite items and then have them share and give away the rest to the local hospital, child care centers or even a favorite charity.

 

Remember, Halloween comes but once a year, besides the trick or treating, there are other fun activities to participate in such as drawing on pumpkins, roasting pumpkin seeds and drawing Halloween cards and posters. I wish and your child a spooktacular and safe holiday. – Dr. Jen