Friday, November 21, 2014

Get Psyched Friday: How Diabetes Impacts a Child’s Self-Esteem

In observance of American Diabetes Month, psychologist Eleanor Mackey, PhD, discusses how diabetes can impact children’s self-esteem or their sense of worth in her latest Get Psyched Friday post.

Type 1 diabetes is one of the most common chronic illnesses in childhood, affecting one in every 400 - 600 children. Managing diabetes requires a substantial amount of mental and physical effort and has to be attended to several times a day. The stress that this can cause is significant – for both parents and their children.

Common Feelings Among Children with Diabetes

The remarkable thing I have seen over and over again is that these children and their families are incredibly resilient and work very hard to manage their illness and continue to have normal, healthy, and happy lives. However, diabetes can have a significant impact on these youngsters, including aspects of their well-being that aren’t easily seen or measured. For example, diabetes can affect children’s self-esteem, or their sense of their own worth.

Feeling Different Because of Diabetes

Despite families’ best efforts, diabetes can feel very defining to kids. Often, teachers and peers may treat them as different, even if well-meaning.  For example, a teacher may set aside a different snack for a diabetic child than the rest of the class. Rightfully concerned parents often ask, “Did you check your blood sugar?” before asking how their child’s day went.

Sleepovers, school trips, and birthday parties all require more thought and parental involvement for children with diabetes than for their peers. Therefore, children may begin to feel defined by their illness and this can cause some children to feel bad about themselves.

Feelings of Failure to Control Blood Sugar

Also, it is important to understand that diabetes is very difficult to manage. It can be hard to achieve the target blood sugar levels and a lot of factors outside a child and family’s control can make this more difficult. Children who are struggling to manage their diabetes might feel a profound sense of failure, which is often accompanied by concern and frustration by their families and medical teams.

What Can Parents Do to Help?

All of these factors can contribute to low self-esteem, which is in turn linked with other difficulties, such as depression, anxiety, and even more difficulty controlling diabetes. Parents should try to keep the diabetes from defining the child, while still being careful to meet their healthcare needs. Two easy ways to do this include:
  • Serve a snack that is low in carbohydrates and sugar to all of the children in a group instead of serving a “special” snack to a diabetic child.
  • Don’t ask a child, “Are you sure you should have that?” Children with diabetes can eat the same foods as other kids with proper planning.
If you are a parent of a child with diabetes, make sure to find plenty of other things to define your child and be aware of subtle changes in your child’s mood or functioning. If you have reasons for concern, seek a consult with your child’s endocrinologist or a psychologist.

Children’s Comprehensive Approach to Treating Diabetes

Your child's visit doesn't end with the endocrinologist's diagnosis and recommendation. The Childhood and Adolescent Diabetes Program at Children’s National focuses on education and teaching patients and families how to cope with all aspects of diabetes and its management.

Program participants have access to a multidisciplinary team of pediatric physicians, certified diabetes educators (CDE), registered nurses, dietitians, a psychologist, and a dedicated social worker.

If you would like to receive occasional information on diabetes management, sign up for our Diabetes Team E-Newsletter.

Related Resources:

Tuesday, November 18, 2014

How to Help Kids Cope with Surgery

Every year, thousands of surgeries take place at Children’s National Health System. Children can feel anxious about getting surgery, which can involve several teams of healthcare providers and other personal.

Children’s National has information both in print and online, titled “Having Surgery,” that highlights many questions parents may have regarding surgery. There is also a section that identifies how to speak with your child about surgery and some examples of language to use depending on the age of the child.

To help families understand how to prepare for surgery, we spoke with two of our certified Child Life Specialists Liz Anderson and Lourdes Rocha, who work in the operating room. Child life Specialists help make families feel comfortable and knowledgeable about the services Children’s National provides.

How can parents help kids feel less anxious about anesthesia and surgery? 

Information about surgery we provide identifies how to prepare a child based on their age. It would also be important to explain anesthesia as a medicine that helps the patient fall asleep for the surgery/procedure, but that this sleep is temporary and that the patient will wake up after their surgery/procedure. Be careful to not explain anesthesia as being “put to sleep” as many children associate this with the death of a pet.

Another resource to lessen anxiety would be for families to attend the pre-surgical tour in person or to watch a virtual tour online if they are unable to attend.

What are some common fears children have about surgery?

Some common fears of younger children are separating from their parents, strangers, and things that go on their body (such as the blood pressure cuff, pulse ox, and IV). Children are also fearful of shots. It is important to note that at our hospital, anesthesia is generally done via mask, and the IV is usually, but not always as this depends on the patient, placed after the patient is asleep with anesthesia.

Older children express fears of not waking up and/or dying, waking up during surgery, pain, and body changes, specifically if surgery will change their appearance in some way.

What tips would you offer to help parents explain the reason for the surgery? How detailed should parents be?

We recommend being honest and appropriate. Parents know their child best and know how much information would be overwhelming for his/her child. It is, however, important to prepare before surgery, and let their child know they are going to come to the doctor to fix or help their current condition.

With young children especially, focus on giving simple, concrete explanations about surgery.  We also prepare children for what they will see, hear, and feel when awake; we do not talk about what surgery entails unless specifically requested by the child.  In these cases, we still use simple, concrete explanations to give information.

Older children or adolescents may be more interested in how things are done and may want more information about the surgery and process.

Related Resources:

Thursday, November 13, 2014

Parent Navigators Help Families Cope, Share Their Own Experiences

When you think of navigators, you may think of someone traveling or exploring new worlds. At Children’s National, we have parent navigators who help other parents figure out the best path of care for their children, especially those with rare or serious illnesses.

Children’s National’s Parent Navigator Program founded by pediatrician Cara Biddle, MD, MPH, provides peer-to-peer support to parents of children with special healthcare needs. The program is located at the main hospital, but offers services at other primary care sites including the Community Health Centers at Adams Morgan, Shaw, Martin Luther King, Jr. Avenue, and Good Hope Road.

The parent navigators have children with rare disorders or special needs, and they work with other parents to help them work through challenges that are common for families like theirs.

“Having this type of peer-to-peer support for the family shows that someone is there who understands what families of children with special needs are going through,” says Michelle Jiggetts, MD, MS, MBA, the program administrator for the Children’s National Complex Care Program and the Parent Navigator Program. “They have walked in their shoes and are sensitive to their needs.” The program employs six full-time parent navigators, two of whom are bilingual. Many families who seek assistance or coaching with their child’s ailments are referred from the Complex Care Program or by primary care physicians to the parent navigators.

Jiggetts also is the liaison for the Maryland Department of Health and Mental Hygiene Office of Genetics and People with Special Healthcare Needs.

Helping the Smallest Patients

Beginning on December 1, Children’s National will be evaluating how parent navigators can help families and infants with fragile medical conditions successfully manage the transition from the Neonatal Intensive Care Unit (NICU) to the home. 

The NICU review will be part of a $2 million grant from the Patient-Centered Outcomes Research Institute (PCORI), headed by Karen Fratantoni, MD, MPH

Stories of Hope

Children’s National parent navigators have moving stories themselves, and they tap into those personal experiences to help others.

Melissa Gaona has a 4 year old with a rare brain anomaly known as pontine tegmental cap dysplasia, a disorder characterized by delays in development, which includes hearing impairment. Gaona also had a parent navigator herself who helped “encourage me, (and) provided resources where I needed to go, and how to cope.”

Now, she is able to tell other families “I know how it feels.”

Yan Orellana is one of the bilingual navigators in the program and he has a son with autism. Because he is a father, he is able to identify with other dads who may be in a “state of denial” or are unable to express themselves freely. “Fathers find it easy to talk to me about their concerns each day,” Orellana said.

Darcel Jackson’s daughter, who has a rare chromosome anomaly, was initially given a life expectancy of at most, 30 days. Her daughter is now 8. 

“As a parent of a special needs child, the journey never ends,” Jackson said. “The goal of the program is to give families the ability to advocate for themselves, understand their child’s needs, and become an active member of their child’s health care team.”

Related Links:

Monday, November 10, 2014

Top 10 Questions Parents Should Ask Their Pediatrician at Well Visits

A well child visit is the best time to talk with your child’s doctor about normal growth, development, and behavior. We’ve put together the top 10 questions you should prepare for your visit.

“Write down your questions ahead of time. Especially if one parent is going and the other is not,” says Children’s Health Center pediatrician Daniel Felten, MD, MPH. “Because if you don’t, the doctor will drive the agenda and you may forget about the things you care about. Also, share your questions right at the beginning of the appointment to ensure they are answered.”

Most well visits last only about 15 to 20 minutes, so here are the 10 common questions to ask your child’s pediatrician and make the most of your time:
  1. Ask about a specific concern you have, like “Why is my child always tired?” or “How can I manage my child’s allergies?”
  2. Is my child’s development and growth appropriate for her age?
  3. What vaccine(s) does my child need during this visit? What does it protect against?
  4. Is everything up to date, and may I get a record of my shots?
  5. What infectious diseases are going around and how can I best keep my kids safe duringx y or z season?
  6. Is my child old enough to graduate from a car seat to booster seat? Is it time to get rid of a booster seat? Can I turn my child’s car seat forward?
  7. When should my kid start using regular toothpaste?
  8. Should my child be going to the dentist?
  9. Is bedwetting normal for older potty-trained kids? 
  10. When should I bring my child back?
“Parents with a child who has special needs should be asking about any additional community resources, especially if the doctor doesn’t bring it up,” says Dr. Felten.

It’s also important to ask questions about any sort of treatment that is being prescribed, according to Dr. Felten. He said that parents should understand the diagnosis, how long to give their child prescribed medicine, and what is the dosage. Do not hesitate to ask the pediatrician to clarify instructions.

Helpful resources:
•    Is my child getting a shot?

Friday, November 7, 2014

Get Psyched Friday: Is Your Child's Temper More Than a Tantrum?

In her latest Get Psyched Friday, psychologist Eleanor Mackey, PhD, talks normal vs. abnormal tantrums. 
 
As a parent, I’ve had more experience than I’d like with the dreaded temper tantrums. From my 2-year-old’s meltdowns over not being able to wear a costume to school or when I forget that she likes to take off the top of the applesauce herself, to my 5-year-old becoming a weepy mess when over-tired.

Normal vs. Abnormal Tantrums

I wrote a post last year on some basics for dealing with meltdowns, but I’ve also recently had parents ask me what distinguishes a developmentally normal tantrum from something they should be concerned about and address. There is some research in this area that has identified key differences between good, old-fashioned tantrums and signs that a child might be struggling with a larger problem, be it sleep deprivation, illness, anxiety, depression, or other mood or behavioral disorders.

Eighty percent of all preschoolers have tantrums from time to time, but it is not typical to have daily tantrums. Normative tantrums are often in response to clear cues like frustration, jealousy, or fatigue. Tantrums that may be cause for concern are more likely to happen without a clear trigger or “out of the blue.”

Key Elements of Normal Tantrums

For preschoolers, here are some key elements of tantrums that have been found to distinguish children with disruptive, depressive, or anxiety symptoms from their healthy peers:
  • Duration of tantrums. Healthy preschoolers tend to have shorter tantrums, lasting less than 25 minutes, whereas children with tantrums lasting longer than 25 minutes may be more likely to have other behavioral or mood concerns
  • Frequency of tantrums. A higher frequency of tantrums may be an indicator of a more serious behavioral or mood concern if tantrums occur:
    • At the rate of more than five tantrums per week at school or outside of the home 
    • 10 to 20 discrete episodes on separate days during a 30-day period at home
  • Quality of the tantrum. The following are all indicators of potentially serious behavioral or mood concerns if they occur during the tantrum:
    • Inability for the child to calm down without the assistance of a caregiver
    • Display of aggression towards other people or objects more than 50 percent of the time during tantrums
    • Attempt to hurt themselves during the tantrum, which may indicate the presence of depression
What Can Parents Do About Abnormal Tantrums?

If your child is showing signs that their tantrums may indicate a larger problem, it is very important that you seek help immediately. Psychologists or psychiatrists who specialize in early childhood are a good place to start. They can help evaluate your child to identify the underlying concerns and create a treatment plan.

It is very distressing to parents and children, as well as disruptive to home and school, when temper tantrums occur frequently and with severity. There are treatments available that can work to improve children’s functioning, the parent-child relationship, and school functioning. Getting your child the help he or she needs can prevent larger problems from developing and can provide him or her with important skills to manage their emotions as a child and as an adult.

Related Posts:
References:
  • Belden, A.C., Thomson, N.R., & Luby, J.L. (2008). Temper tantrums in healthy versus depressed and disruptive preschoolers: Defining tantrum behaviors associated with clinical problems. Journal of Pediatrics, 152, 117-122.
  • Wakschlag, L.S., Choi, S.W., Carter, A.S., Hullsiek, H., Burns, J., McCarthy, K., Leibenluft, E., & Briggs-Gowan, M.J. (2012). Defining the developmental parameters of temper loss in early childhood: Implications for developmental psychopathology. Journal of Child Psychology and Psychiatry, 53 (11), 1099-1108.

Thursday, November 6, 2014

How to Treat Lice and Prevent It From Spreading

When your child reaches for his scalp and starts to vigorously scratch, parents pray for dandruff. But, often for school-aged children, this itch is caused by lice and with this guide; it doesn't have to be scary.

Head lice, or Pediculus humanus capitis, are parasitic insects that can be found on human hair – head, eyebrows, and eyelashes – according to the Centers for Disease Control and Prevention. While lice do feed on human blood and live close to the scalp, they are not known to spread diseases. Additionally, a child infested with lice is not a sign of poor hygiene.

Children’s National Health System's pediatrician Lee Beers, MD, advises parents to keep calm if they find a louse or nit (lice eggs) in their child’s scalp.

“Don’t panic – it’s very common. Second to the common cold, it’s the most contagious infectious disease a child can get,” Dr. Beers said.

How do you check for head lice?
  • Seat your child in a brightly lit room
  • Part the hair and look at your child's scalp
  • Look for crawling lice and for nits
    • Live lice are difficult to find - they avoid light and move quickly
    • Nits will look like small white or yellow-brown specks and be firmly attached to the hair near the scalp, the easiest place to find them is at the hair line at the back of the neck or behind the ears
    • Nits can be confused with many other things, such as dandruff, dirt particles, or hair spray droplets
  • Use a fine-toothed comb to help comb out the lice or nits. Comb through your child's hair in small sections. After each comb-through, wipe the comb on a wet paper towel. Examine the scalp, comb, and paper towel carefully.
Dr. Beers suggests wetting the child’s hair with conditioner or olive oil and pay special attention to the nape of the child’s neck when checking for lice.

Once the lice are found, make sure to inform your child’s school, then, think about how you want to treat the lice.

Treating Lice:
  • Chemical method is the most effective method of treating lice
    • Purchase shampoos or cream rinses that contain 1 percent permethrin, the chemical that treats lice
    • Read labels carefully, as some treatments have age-restrictions
    • You may need to use more than one treatment. The American Academy of Pediatrics recommends a second treatment 7-10 days following the first one
    • Comb through treated hair to remove remaining nits
    • Consult a pediatrician if you have any questions
  • Comb-out method is less effective and may take longer to remove the lice
    • Comb out damp hair with a fine-tooth comb every day for about two weeks
“Additionally, parents should wash sheets, bedding, towels – anything that has touched the child’s hair in the past 24 hours – with hot water and dry in high heat,” Dr. Beers said. “And anything that can’t be washed, like a stuffed animal, should be sealed in plastic bags for two weeks.”

How to keep lice from spreading in the family?
  • Avoid touching each other’s’ hair, especially girls who like to braid each other’s hair
  • Don’t share hats and combs
  • Avoid wrestling
  • Treat everyone in the household – this goes for parents too
Dr. Beers said that once treatment has begun, the child should return to school. While lice can take about two weeks to go away completely, this is not a reason for children to unnecessarily miss school.

If you have questions about lice, ask your child’s pediatrician.

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.

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