Friday, October 31, 2014

Get Psyched Friday: How to Help Kids with Homework

In her latest Get Psyched Friday, psychologist Eleanor Mackey, PhD, shares best practices for helping kids with their homework at any age.

Now that school is back in full swing, many households are dealing with how to handle homework. We are in this boat for the first time now that our oldest is in kindergarten. At this stage, the novelty of being old enough for homework is carrying us through, but we know that this will end sooner than we would like. Therefore, I wanted to look into some best practices for helping kids with their homework at any age.

Helping your child be successful at homework is very important because it is a very critical part of children’s academic success. Homework helps children in several ways, including:
  • continues learning after the school day
  • teaches responsibility
  • helps parents stay aware of what their child is learning in school
Being involved in your child’s homework is important. As with all parenting endeavors, though, there is a fine line between being too involved and not being involved enough.

So, what’s a parent to do?

Step 1: Set Expectations

Set up appropriate expectations for your child and their homework responsibilities. For example, depending on the age of your child, they might be responsible for determining which homework needs to be done, doing the actual homework, and putting their completed homework into their backpack.

It is very important that the child take responsibility for the actual homework, not the parent. A parent might commit to finding a quiet space for the child to do the homework, checking answers, double checking that everything has been done, as well as being on hand to answer questions.

Step 2: Set Up a Good Study Space

There must be a designated homework space in the house free of noises and distractions. If possible, try to make this fun. For instance, a colleague of mine mentioned she got her kindergarten-aged son a “homework box” that has everything he needs including pencils, erasers, scissors, etc. He puts his homework folder by the box when he comes home and then has everything he needs. I think this is a great idea to help with organization for any age.

Step 3: Schedule When Homework Will be Done

It is important to teach kids that homework must be done on time. Set aside a certain time of the evening for homework to be completed. Put it in the calendar like any other activity so that there is always time for it. Younger kids will need the schedule made for them. Children older than 10 years of age may be able to take charge of putting homework and specific assignments into the schedule and then have a parent check it for them.

For younger grades, there is usually homework that is shorter-term and due in quick succession, which can be easier to manage and plan.

For older kids, often there is advanced planning that needs to be done, for example a term paper. Help your kids learn how to break up long-term assignments into chunks and assist in planning when each section will be completed.

Step 4: Motivate!

Your encouragement goes a long way towards motivating your child to do homework. Praise your child for steps along the way, not just successful completion of homework. For example, praise them for remembering their homework, for stopping other activities without complaint when it is homework time, for continuing a challenging task, or for good grades.

It is best to build internal motivation for homework, or the desire to complete it for their feelings of pride in good work done and for caring about their academics. However, some kids may benefit from external motivators, such as earning a pass from other chores in exchange for doing homework or earning the ability to engage in preferred activities when homework is done.

Still having homework challenges?

If your child is having more difficulty with homework than what these steps can help with, there are some additional steps you can take. For more pointers, I like the book Homework Without Tears by Canter and Hausner. It may also be important to talk with your child’s teacher to strategize on how to help your child. You may also want to consult a psychologist to determine if educational testing may benefit your child.

Other Helpful Blogs:

Monday, October 27, 2014

2014 Flu Prevention Plan: Wash Your Hands, Get a Flu Shot

Staying healthy through the annual influenza season can be tough, but with advice from Infectious Disease Specialist David Hyun, MD, you and your family can make it through.

The flu, or influenza virus, plagues us each year and some children can become seriously ill. Flu season starts in the fall and ends in the spring. According to the American Academy of Pediatrics influenza viruses cause respiratory illnesses that can last a week or longer. Symptoms include:
  • A sudden fever (usually above 101°F or 38.3°C)
  • Chills and body shakes
  • Headache, body aches, and being a lot more tired than usual
  • Sore throat
  • Dry, hacking cough
  • Stuffy, runny nose
  • Some also experience vomiting and diarrhea

Watch Dr. Hyun's video to learn how you can protect your family this flu season:

Wednesday, October 22, 2014

Is Baby-Led Weaning A Safe Way to Feed Your Infant?

When a few of my new-mom friends started asking me about introducing solid foods and if I had done baby-led weaning, I gave them a blank stare. When I hear the word “weaning,” I think about transitioning a baby from breast to bottle, or formula to whole milk. But it turns out baby-led weaning is a term that describes a way to introduce solid foods to babies, and it skips the puree or mushy-food phase.

I had never heard of this concept when my daughter was an infant, and I had already begun introducing food to my son when a few friends started asking me about it. So I talked with Penny Glass, PhD, who directs the Child Development Program and is an expert on infant and child development, to get her opinion on introducing new foods to babies.

When should babies begin eating food?
“Most pediatricians say to wait until babies are 6 months,” says Dr. Glass. If a baby was born prematurely, parents should factor in their development. The main reason that babies need more than breast milk at that age is because they need more iron, says Dr. Glass.

Are there any benefits to starting babies on purees?
The idea of exposing babies to different flavors of foods and aromas is a positive one and can help whet their appetites, says Dr. Glass. And it’s typical for babies to have to try something 17 times before they like it, says Dr. Glass.

When should babies start feeding themselves?
There is no right age, but it’s really when babies have the ability to do so. Look for developed oromotor skills, like gripping, and body tone before letting babies feed, says Dr. Glass. She cautions against putting unnecessary pressure on your baby to get them to feed themselves.

“Americans in particular are very strong about wanting their babies to be independent and feeding early, but this can cause some trouble,” says Dr. Glass.

When babies are very young, they aren’t very good at feeding themselves, so they may become frustrated because they are still hungry, but are not able to eat enough. Dr. Glass suggests that parents start by offering bites from a spoon and once the baby has had a few bites, parents can let the baby “practice” on their own.

Also, as they get older, Dr. Glass says babies may decide to select certain foods or not want to try a variety, which may cause tension and frustration at the dinner table.

Is choking a concern with baby-led weaning?
Proponents of baby-led weaning say that babies’ gag reflexes prevent them from choking. But Dr. Glass says that some may have stronger responses and throw up, which causes an unpleasant experience for both the baby and caregivers. A common reaction is for parents to panic when a baby is choking, and it can create a bad cycle that leads to unpleasant mealtimes, says Dr. Glass.

Additionally, even at a young age, babies are paying attention to parents’ reactions. If a parent looks panicked, Dr. Glass says a baby can change their behavior based on a parent’s reaction.

Do you see any benefits to baby-led weaning?
“Anything that brings a parent to the table with their baby has some merit,” says Dr. Glass.  Babies learn by watching, so they watch parents chew and socialize. It’s also a great way to expose babies to new foods. Exploring new flavors and “gumming” foods is a very positive and appropriate experience.

Why is eating together so important?

Around 6-9 months of age, babies become intent on watching and learning from people, and this includes how people talk and eat. Coming to the table together is a great social and language learning opportunity.

Dr. Glass says the focus should be on keeping meals as pleasant and relaxed as possible – no matter the method parents choose to feed their children. Individual differences and cultures should be appreciated.

One tip Dr. Glass offered is one that she practiced with her own children: have breakfast together.  As her children got older, she found they were rushed in the mornings before hurrying off in several different directions. Her solution was to wake up a few minutes earlier so she could have breakfast every morning with her children.

“It’s important to make emotional contact before we rush off,” says Dr. Glass. “It’s an incredible experience for a child – and a parent – to make a connection before the day really gets started.”

Monday, October 20, 2014

Guide to Celiac Disease and Gluten-Free Diets

More than 2 million people in the United States have celiac disease, or about 1 in 133 people, according to The National Institutes of Health. It was once considered a rare childhood syndrome, but is now recognized as a common genetic disorder.

What is celiac disease?
Celiac disease is an autoimmune disease, meaning that the immune system responds inappropriately against substances or tissues normally present in the body. For people with celiac disease, the body cannot tolerate gluten, a protein found in wheat, rye, and barley. Not only can the disease cause discomfort to the child with celiac disease, but it also damages the small intestine and inhibits the absorption of nutrients from food.

What does it affect?
When children with celiac disease eat food that contains gluten, the immune system damages the small intestine’s villi, which are tiny fingerlike hairs that help to absorb nutrients from food. Without healthy villi, a child can become malnourished. If a child is left undiagnosed, damage can occur in nearly every system of the body, from skeletal to neurological.

“Because it can affect any part of the body, it often isn't thought of when people have difficulties and so it is missed for a very long time,” said Children’s National Health System John Snyder, MD, in an interview with CNN. Dr. Snyder is the Division Chief of Gastroenterology, Hepatology and Nutrition and Director of the Celiac Disease Program.

What are the symptoms?
The symptoms of celiac disease vary. Originally, researchers thought that gastrointestinal complications were the only symptom; however, because this disorder has now been found to affect the entire body, there is a wide range of symptoms.

Gastrointestinal Symptoms:
  • Diarrhea
  • Lactose Intolerance
  • Abdominal Distention
  • Change in appetite
  • Colitis – can have blood in the stool with CD
  • Constipation
  • Dyspepsia – “stomach aches”
  • Bacterial overgrowth
  • Malabsorption
  • Flatulence
Dermatologic and Mucous Membranes:
  • Dermatitis Herpetiformis
  • Eczema
  • Psoriasis
  • Vitiligo
  • Acne
  • Rosacea
  • Urticaria – hives
  • Vasculitis – inflammation of blood vessels
  • Depression – bulk of serotonin found in the intestine, not the brain
  • ADD/ADHD/Autism Spectrum Disorder (although no studies have shown a definitive link between celiac disease and ADD/ADHD/autism, many families feel their children have improved on a gluten-free diet)
  • Hypochondria
  • Inability to concentrate, “brain fog”
  • Anxiety
  • Neurosis
  • Moodiness
  • OCD – Obsessive-Compulsive Disorder
These are just a few examples of symptoms experienced by those who suffer from celiac disease. Children with celiac disease often have other autoimmune diseases too, such as:
  • Type 1 Diabetes (juvenile onset)
  • Hypothyroidism (Hashimoto’s Disease)
  • Hyperthyroidism (Grave’s Disease)
  • Secondary Hyperparathyroidism
  • Sjogren’s Syndrome – dry eyes and mouth
  • Addison’s Disease – atrophy of adrenal glands
  • Autoimmune Liver Disease
  • Dilated (congestive) Cardiomyopathy – inflammation of heart muscle
  • Alopecia Areata – patchy hair loss
  • Rheumatoid Arthritis
How is it diagnosed?
Celiac disease is first diagnosed through a blood test. The blood test is looking for high levels of antibodies, since the bodies of individuals with celiac disease attack gluten protein as a foreign substance. If the results of the test are unclear, the child would have to undergo an endoscopy, where a small biopsy of the small intestine to determine if celiac disease is present.

What is the treatment?
So, how is celiac disease treated?

The good news about this genetic disease is that it’s manageable.

“With a 100 percent gluten-free diet and 100 percent healing of intestinal villi,” said Children’s National’s Celiac Disease Program dietician Cheryl Molinatto. Molinatto helps families cope with the disease and teaches them how to remove gluten from their child’s diet.

At Children’s National, the multidisciplinary Celiac Disease Program aims to improve the way celiac disease is diagnosed and treated. A child who visits the program will meet a team of physicians, nurse practitioner, dietician, psychologist, and a community mentor. The mentor is either an individual living with celiac disease or the parent of a child with celiac disease, who can help guide the family through the process of going gluten-free and the ups and downs of celiac disease.

A dietician like Molinatto will send the child home with a Getting-Started Kit that includes a celiac disease and gluten-free handbook, a reusable shopping bag filled with gluten-free food items, a toaster, and his or mentor’s contact information.

“I teach families how to prevent cross-contamination, dine out, and school lunch safety,” she said. “I also help the family identify gluten-free foods that they’re already eating.”

There is a lot to learn when a child goes gluten-free. Gluten protein is in breads, but it’s also found in Teriyaki sauce, ground spices, lipstick, flavored yogurt, etc. Molinatto encourages caregivers and siblings to attend a child’s appointments so that the whole family is well-informed.

A gluten-free diet does not need to be difficult, as fruits, vegetables, meat, poultry, and milk are all naturally gluten-free. And as with any diet, it can be healthy or unhealthy depending on what foods are chosen.

Sign-up for Children’s National’s Celiac Disease Digest for up-to-date information and gluten-free recipes for the whole family.

Wednesday, October 15, 2014

How to Keep Your Kids Safe This Halloween

Before you join your ghosts and goblins for a night of trick-or-treating, read these tips to keep them safe in their costumes, eating candy, or walking around the neighborhood.

We spoke with Children’s National Health System’s Education, Prevention, and Outreach Coordinator Sally Wilson, BS, RN, to find out the best safety tips for Halloween.

She said a good trick to keep kids safe is to slip a piece of paper in their treat bag that identifies the child’s name and where he or she lives, in case the child is separated from the group.

Costume Safety

“One of the basics is to make sure your child’s costume isn’t too long, so he or she doesn’t trip and fall,” Wilson said.

Here’s a checklist of costume safety from Safe Kids Worldwide:
  • Avoid masks or head gear that blocks vision, long costumes or awkward shoes that could cause a fall, and loose or non-fire-resistant material that could ignite near a candle.
  • Use hypoallergenic makeup for face painting instead of masks that could block vision. Don't apply makeup too close to the eyes. 
  • Make sure swords and other accessories are made of cardboard or other flexible materials. 
  • Mark costumes and accessories with reflective tape and provide flashlights.

Candy Safety

Wilson says that parents should not let children eat candy while trick-or-treating, until you have time to check it.

 “Make sure your child eats dinner before they go,” she said. “And only eat commercially approved treats, unless you know the neighbor personally.”

Here are some other candy safety tips from Safe Kids:
  • An adult should check sweets for signs of tampering before children are allowed to eat them.
  • Remind children to only eat treats in original and unopened wrappers.
  • Throw away candies if wrappers are faded, have holes or tears, or signs of re-wrapping. When in doubt, throw it out!

Pedestrian Safety

Wilson is passionate about promoting pedestrian safety and since Halloween encourages walking from house to house, she has many tips on this subject.

She stressed that children younger than 12 years old should always be accompanied by an adult. Children should also be careful when crossing the street, and only cross at corners.

“When I had done some research on this, one of the significant issues is that adults drink and drive and that’s an issue for children,” she said. “Because kids get excited, dart around, and get hit. We need to encourage children to use their safety rules.”

According to Safe Kids, children are more than twice as likely to be hit by a car and killed on Halloween than on any other day of the year.

Kids should also be mindful of cars in driveways. It becomes darker earlier in the fall and kids can be more difficult to see when a car is backing out of a driveway.

“Most people don’t do this, but parents need to discuss the route of trick-or-treaters, know who they’re going with, and only travel in familiar areas,” she added. “And don’t go into a stranger’s home, particularly ones that are not well lit. Establish the route and a return time.”

Below are more tips from Safe Kids on walking safety.
  • Cross the street at corners using crosswalks and traffic signals.
  • Children younger than age 12 should cross streets at night with an adult.
  • Walk on sidewalks or paths. If there are no sidewalks, walk facing traffic as far to the left as possible.
  • Have kids carry glow sticks or flashlights for added visibility to drivers.
  • If older kids are trick-or-treating without adult supervision, parents should make sure they go in a group and stick to a predetermined route with good lighting.
Have a safe and fun Halloween!

Tuesday, October 14, 2014

How to Keep Young Athletes Safe While Playing Sports

Nonprofit advocacy group Safe Kids Worldwide, an affiliate of Children’s National Health System, recently released a study of youth sports injuries.

The group surveyed 1,000 young athletes, 1,005 coaches, and 1,000 parents, finding that 90 percent of the athletes reported being hurt while playing a sport. While most of the reported injuries were minor such as bumps and bruises, 37 percent of the injuries involved sprains or strains, 24 percent dehydration, 13 percent broken bones, 12 percent concussions or head injuries, and 4 percent a torn ligament injury, according to the report.

Founded in 1988, Safe Kids Worldwide is a global network of organizations dedicated to preventing unintentional injury.

With sports starting up for schools across the country, fall is a good time to get the word out about sports safety. Suzanne Jaffe Walters, MD, a Children’s National orthopaedic surgeon who specializes in sports medicine, discussed sports-related injuries and the culture of youth sports.

Dr. Walters said the most common injuries (acute and overuse) she treats include anterior cruciate ligament, or ACL, tears; meniscus tear, a common knee injury; shoulder dislocations; ankle sprains; and Osgood-Schlatter disease, an inflammation of the bumpy part of the upper shinbone called the anterior tibial tubercle.

Citing the American Academy of Orthopaedic Surgeons, Dr. Walters offered the following tips for engaging in sports:
  • Be physically fit 
  • Know and abide by the rules of the sport
  • Wear appropriate protective gear
  • Know how to correctly use athletic equipment
  • Warm up before playing 
  • Stay hydrated
  • Avoid playing when very tired or in pain
Dr. Walters noted that some young athletes continue to play even if they’re hurt because they do not want to feel humiliated if they leave the game, and also desire to keep up with their teammates. Additionally, she said they’re afraid that stepping away from the game adversely affects their position on the team, or that they’re letting down the coach and their parents.

“Also, a lot of kids are having fun and don’t want to stop,” she said, adding that what drives many to stay in the game is “a desire to win.”

“If you start to feel fatigue and you’re starting to have pain and it’s not going away, you need to take yourself out of the game,” she said.

With injury prevention, it is important to have parents, coaches, and players all aware of every athlete’s individual limits and make sure that no one is surpassing that through extra-long gameplay and practice while hurt.

She also cautioned against young athletes about playing against children who are older or bigger than they are. Often, that is “when smaller players tend to get hurt,” she said, adding that “playing peers of similar size and similar skill levels” the athlete is “less likely to be injured.”

Monday, October 13, 2014

Pediatrician: Sofas are ‘extremely hazardous sleep surfaces for infants’

Parents and caregivers need to be aware of the dangers of infants sleeping on sofas, says Rachel Moon, MD, a pediatrician and SIDS researcher at Children’s National Health System.

In a study published online Monday in the November 2014 issue of the journal Pediatrics, Dr. Moon and other researchers found a strong association between sleeping on sofas and infant deaths.

“Too many people simply don’t know the risks of having infants sleep on sofas,” Dr. Moon said.

Dr. Moon and other researchers studied information supplied by 24 states from 2004 through 2012 to the National Center for the Review and Prevention of Child Deaths Case Reporting System database. They found that of more than 9,000 sleep-related infant deaths, about 1,000 occurred on sofas. About 72 percent of the deaths involved babies aged 0 to 3 months.

Some studies have shown that, compared to other surfaces, sleeping on a sofa places a baby at a 49 to 67 percent increased risk for death, says Dr. Moon, who is also Associate Chief of the Division of General Pediatrics and Community Health for Children’s National and professor of pediatrics at the George Washington University School of Medicine and Health Sciences.

“Soft bedding, sleeping somewhere other than in a crib, (e.g. sofa), surface sharing (when an infant is sleeping on the same surface as another person), and bumper pads contribute to an unsafe sleep environment,” the report stated.

Sleeping on a couch raises the risk of suffocation and entrapment in the cushions.

“I don’t think most parents know that the sofa is a dangerous place,” Dr. Moon said. “They see it as a logical place to put the baby. If they are in the living room, and doing other things such as watching TV, or talking to other people, it feels like it makes sense for them to put the baby right there. In other instances, parents may come home from work, and they want to snuggle with the baby, put the baby on the couch, or have the infant on top of them. Then they fall asleep and the baby rolls off the parent’s chest and gets stuck between the parent and the sofa.”

Their study found that infants who died on sofas were likely to be found on their sides. The side position puts infants at risk for suffocation when the baby’s face is against a cushion or person.

Sudden infant death syndrome (SIDS) is the leading cause of infant mortality after the first 30 days of life in the U.S., with the rate of 53.9 percent of deaths per 100,000 live births.

For more tips on how to reduce the risk of SIDS for babies and information on other SIDS studies led by Dr. Moon, visit our SIDS Resource page.