Friday, December 19, 2014

Get Psyched Friday: 8 Ways to Encourage Kids to be Holiday Helpers

In her latest Get Psyched Friday post, psychologist Eleanor Mackey, PhD, offers ideas on how to involve children in this year’s holiday preparations.

In the midst of the holiday season, it’s important to get children involved in your family’s holiday activities and preparations. During this time of year, parents’ stress levels can become highly elevated with the need to get many chores done in time for the holidays.

When pressure and stress are high, parents may sometimes find themselves not including kids in the process, knowing that it takes both time and supervision. However, this inclusion is important for increasing cooperation and happiness in kids, and it also can be a valuable time for family bonding.

Try these eight ideas to involve your children in this year’s holiday preparations:
  1. Make decorations: Most kids love art projects, so involve them in preparing decorations such as making place cards or menus
  2. Create thank you cards: Get a jump start on thank you notes by having your kids create cards or write addresses on envelopes
  3. Plan a menu: Take your child grocery shopping and let them help select a menu for a holiday meal
  4. Set the table: Ask your child to help set the table – even two-year-olds can be really good at this
  5. Be a DJ: Let an older child design a music playlist as background sound for a holiday party
  6. Read holiday books: Read holiday-specific books, listen to holiday music, or participate in a fun family activity to get them engaged in the season
  7. Volunteer: Consider participating in a community service activity like working at a food bank, donating toys, or volunteering at a senior center to increase gratitude and a sense of giving for the season
  8. Make goodie bags: Ask kids to help make bags of goodies or other little holiday presents for teachers, coaches, or anyone else you acknowledge on the holidays
Although it may take more time and effort on your part to involve your kids, it is a great way to make sure they are engaged in your family’s traditions and holiday spirit. It also can be an excellent opportunity to spend time together and work on family projects. Ask your kids what they would like to help with – they might surprise you!

Related Resources:

Wednesday, December 17, 2014

Monitoring Eating Disorders in Children

During the holiday season, gathering around the dinner table is an especially meaningful time for parents, children, relatives, and friends. It’s also a good opportunity to focus on helping a child who refuses to eat, or one who doesn’t want to stop eating.

Some children often don’t feel hungry and would rather play than eat, or they may be so picky that they eat a very limited number of foods. There are other children who love to overeat because it’s simply a pleasurable experience and they don’t know when to stop. 

Irene Chatoor, MD, Vice Chair of Children’s National Health System’s Department of Psychiatry and Behavioral Sciences and Director of the Infant and Toddler Mental Health Program, counsels parents of children with eating problems and disorders.

“Eating as a family is at the center of celebrations,” Dr. Chatoor said. “It is a particularly trying time for parents when a child won’t eat or eats too much.”

Counseling is important for children as young as 9- or 18–months old because that’s when they become more mobile, develop a sense of self, and begin self-feeding. They also start to exhibit oppositional behavior.  Children may have ongoing difficulties unless there are early interventions, Dr. Chatoor said.

Whether they eat too much or too little, Dr. Chatoor urges parents that they shouldn’t praise or criticize children, or use food as a reward or expression of affection.

When Children Don’t Want to Eat

Some children are so excited about playing that they don’t seem to notice when they are hungry, Dr. Chatoor said. Toddlers may not want to get in the highchair to eat, prompting their parents to try all kinds of things to encourage them to eat.

Children also may use food refusal to gain control over their parents. Dr. Chatoor said one mother put it so well, saying, “I have a two year old executive in my house.”

By not understanding these different eating issues, parents may try to distract and coax their children to eat.  Some parents get so desperate that they hover over them or even force feed them. “That can make matters worse,” Dr. Chatoor explains.

How to Encourage Children to Eat

Here are some of Dr. Chatoor’s suggestions to help alleviate some of these concerns:
  • Have three regular meals and a mid-afternoon snack to allow children to experience feeling hungry and feeling full, so they learn how to eat accordingly. 
  • If your child gags or vomits upon trying a new food, keep your mood neutral, but make a mental note and do not to serve that food again. Children with strong sensory reactions consistently refuse the same foods, and forcing them to eat those foods makes them more aversive and distrustful of trying new foods.
When Kids Eat Too Much

On the other hand, some children want to continue eating and don’t feel they are finished, even when it seems obvious to parents they shouldn’t have more.  These children have “poor awareness of fullness and don’t know when to stop,” Dr. Chatoor said. “When they see palatable food they want to eat it, just by seeing it, regardless of whether they just ate and should be full.”

Dr. Chatoor offers these tips for parents: 
  • Since overweight children tend to eat too fast, help your child to “slow down,” by offering small portions of food. Offering small portions will also help the child recognize when he or she is full.
  • Never restrict the child at mealtimes, and only offer another small portion once they have eaten what was on their plate. Ask the child whether he is still hungry and or whether he is full.Prepare three regular meals, which should be at least three or four hours apart, and a mid-afternoon snack. There should be no eating or drinking between except water.
  • Do not keep snack foods and sweets around the house to tempt children.  Occasionally, offer small portions of candy or their favorite dessert and allow the child to eat the snack food first if that is what he or she prefers.
  • A trick of the trade: Use celery or a child’s “non-preferred” food.  Offer some celery with food, and gradually increase the size of the celery piece while reducing other foods. At that point, the child stops eating “without the pleasurable experience” of food in their mouth, Dr. Chatoor said.
Research on Eating Disorders

Dr. Chatoor is an expert in childhood eating disorders and has authored many studies on specific eating problems. In fact, Dr. Chatoor presented some of her latest research last fall at the Academy of Child and Adolescent Psychiatry workshops in San Diego.

She noted in her research that several eating disorders could occur simultaneously in children, including apparent lack of interest in eating or even feeling ill, which Dr. Chatoor has described as “post-traumatic feeding disorder.”

Dr. Chatoor also described findings in a study of 7 to 13 year olds, noting that while two-thirds of children had outgrown their eating problems, one-third continued to show “poor appetite and growth, lack of interest in eating,” coupled with sleep and anxiety disorders. Lack of regular family meals and not eating lunch at school separated a “poor growth group from those who had outgrown their problems,” Dr. Chatoor reported.

For more information on feeding disorders and case studies on feeding disorders, read Dr. Chatoor’s e-book When You Child Won’t Eat or Eats Too Much.

Relevant Resources:

Friday, December 12, 2014

Despite ‘Drift’ Flu Vaccine Remains Best Protection

This year’s flu season is underway in the Washington, DC metropolitan region, but early indications are it may not only be a tough one, but the flu vaccine will not be as effective as hoped.

Nevertheless, a vaccine is one of the best defenses against the flu.

“The CDC continues to emphasize that getting vaccinated is still the best way to prevent and combat flu. The overall effectiveness of the vaccine in our population may very well be lower this year because of the ‘drift’ but vaccinated individuals have a good chance of having ‘cross-protection’ against the circulating H3N2 strain,” Children’s National infectious disease specialist David Hyun, MD, said.

Health officials warn an aggressive influenza strain, H3N2 strain, has changed or mutated after vaccines were distributed and is currently widely circulating. And early data collected by the Centers for Disease Control and Prevention (CDC) suggest a harsher than normal flu. Changes or mutations in the strain may reduce the effectiveness of the flu vaccine.

"For each flu season, experts and epidemiologists have to make predictions 9-10 months in advance of what the most likely circulating strains will be,” Dr. Hyun said. “This is because it takes that much time for the vaccine manufacturers to accommodate those predictions/selections of the strain and have the vaccine products ready by August/September. So, for this flu season the experts made the selections of which strains should be targeted for protection in the vaccine all the way back in March."

Does The Vaccine Cover All Viruses?

The CDC is “expressing caution that the vaccines may not provide high levels of protection because of the differences between the circulating strain and the vaccine strain,” Dr. Hyun said.

Dr. Hyun said this isn’t unusual and changes in the circulating strains happen every few years.

“In past years, you may have heard news outlets describing, during the flu season, that the vaccine was ‘not a good match’ for the flu strains circulating. Basically it’s the same thing,” Dr. Hyun said.

A ‘Drift’ Doesn’t Mean Vaccines Are Useless

“None of the announcements have any implications for vaccine safety,” Dr. Hyun said. “Vaccine safety is still expected to be the same as before with the same contra-indications in place.”

Are There Any Universal Vaccines?

“Ideally we would love to have a vaccine that universally covers all strains and that is being researched,” Dr. Hyun said, adding that research indicates that “we may not be that far away from this becoming a reality.

“But in the meantime, we are still limited on how many strains we can provide protection for in a single vaccine,” he said.

The CDC warning is also important because some of the most severe flu seasons have occurred when the H3N2 strain was most prevalent.

Flu Vaccine Remains the Best Protection

It is still best to get vaccinated.

“It may have some genetic changes but it's still an H3N2 strain and continues to share many common genetic features with the vaccine H3N2 strain,” Dr. Hyun said. “This cross-protection may be enough to prevent a vaccinated individual from getting infected or even in infected individuals may provide enough immunity to temper the severity of the disease.”

Not Too Late to Vaccinate

The flu shot or nasal spray is the best tool for prevention.

“It's never too late to receive a flu vaccine during the flu season,” Dr. Hyun said.

Vaccination will protect against strains other than H3N2.

“Even if H3N2 is the predominant strain this season, there will still be a baseline level of H1N1 circulating as well and the vaccine can provide protection against it,” Dr. Hyun said. “In addition, you also get protection against the Influenza B strains which will circulate March once H3N2 fades out.

Ways to Avoid the Flu

Dr. Hyun said hand washing is the best prevention against the spread of germs. Stay home when sick. And properly cover your coughs. Learn more about how you can protect your family this flu season.

National Influenza Vaccination Week, which started Sunday and ends tomorrow, was established to focus attention on the importance of flu vaccines. The flu season typically lasts several months, peaking in January and February before ending in late winter or early spring.

Some of the flu-like symptoms to monitor in your kids include:

  • Fever
  • Cough
  • Sore throat
  • Body aches
  • Headache
  • Vomiting or diarrhea

  • Wednesday, December 10, 2014

    Children’s National Introduces New Treatment Option for Scoliosis Patients

    Orthopaedic surgeon Jeffrey Hanway, MD, poses with the
    MAGEC growing rod.
    Children’s National Health System is among the first in the country to offer a spinal growing rod for children with scoliosis. The MAGEC™ (MAGnetic Expansion Control) Spinal Growing Rod is a non-invasive treatment for children with early onset scoliosis.

    About Current Growing Rods

    Growing rods have become effective tools for children whose spinal curvature is too significant to control with bracing or casting. The rods—which are surgically attached to the spine above and below the curve and then lengthened during follow-up surgical procedures—allow the spine to continue growing while managing the curve until the child is old enough for spinal fusion.

    Children must bear the physical and psychological burden of undergoing lengthening procedures every six to 12 months until they are skeletally mature enough to have spinal fusion—typically around age 10 for girls and age 12 or 13 for boys. The procedure also has a recovery period following each surgery, meaning some missed school days.

    Why MAGEC Growing Rods are Different

    MAGEC rods are similar to traditional growing rods in that an orthopaedic surgeon attaches them to the spine through an incision in the patient’s back, a procedure requiring several days of inpatient recovery. Unlike conventional growing rods, however, the surgeon lengthens the MAGEC rods in minutes during subsequent outpatient visits every three or four months using the MAGEC External Remote Controller (ERC)—no surgery required. The ERC is like a magnetic wand and as it is waved over the back, it lengthens the rods internally. Because the follow up procedures can be done in the outpatient setting and are non-invasive, patients recover faster and can return to school sooner.

     “Traditional growing rods work, but they require multiple surgeries that increase complication rates and time spent in the hospital,” says Matthew Oetgen, MD, Interim Division Chief of Orthopaedic Surgery and Sports Medicine and Director of Orthopaedic Research at Children’s National. “We treat many children each year who have or are candidates for growing rods, so it’s important for us to embrace new technology to make the lengthening process easier and less painful for children while decreasing morbidity.”

    First to Use MAGEC Growing Rods in Washington, DC

    Following MAGEC’s approval by the U.S. Food and Drug Administration in February 2014, surgeons at Children’s National performed two of the first 15 MAGEC implantations in the country, and the first in the greater Washington, DC, area. Jeffrey Hanway, MD, and Shannon Kelly, MD, orthopaedic surgeons, each performed a case at Children’s National on May 6.

    “My patient was a somewhat atypical candidate because he was 10 years old, but he was a young 10, skeletally speaking,” Dr. Hanway says. “A brace adequately managed his curve for a while, but by this spring, a slow increase in the bend had pushed it past 50 degrees. When MAGEC became available, I said, ‘This is ideal for him.’ If he can continue with MAGEC for two or three years, he’ll be in a good place in terms of readiness for spinal fusion.”

    Read more about the MAGEC growing rod's ongoing research in Advancing Pediatrics.

    Monday, December 8, 2014

    How to Manage Your Child’s Food Allergies through the Holidays

    During this time of year, it is common for children to attend school celebrations or gatherings with family and friends. For parents whose children have severe food allergies, the winter holidays can be very challenging.

    Being knowledgeable and doing research plays a big role in helping educate friends and family about food allergies. Allergies are the result of a reaction that starts in the immune system when coming into contact with a food allergen. Allergies can cause great harm or death in severe cases, not only at family homes but when kids visit friends and they’re not aware of the child’s condition.

    For tips on managing food allergies, we turned to Darlene Mansoor, MD, a pediatric allergist, immunologist and an attending physician in the Allergy Clinic in the Center for Cancer and Blood Disorders at Children's National Health System.

    Common Food Allergies and Substitutes

    According to Dr. Mansoor, the most common food allergies are dairy, egg, soy, wheat, peanut, tree nuts, fish, and shellfish with “sesame becoming more common.”

    When considering food/ingredient substitutes as you prepare dishes for your family, Dr. Mansoor recommended using allergen-free recipes. She said the American Academy of Allergy, Asthma and Immunology (AAAI) website features this information including holiday recipes. “With a little preparation and creativity nearly any recipe can be made allergy free and safe to eat for anyone,” Dr. Mansoor said.”

    Awareness and Education is Key to Managing Food Allergies

    “It’s very important to read labels for ingredients in store bought foods. For homemade foods, ask the person who made the food directly what ingredients was used,” Dr. Mansoor said. “If there is a doubt it’s better to avoid. Be aware of cross contamination during preparation. If you don’t feel comfortable eating the food then you don’t have to. I would recommend parents prepare a safe snack for the child to take to a party. Make enough to share in case other family members want to try.”

    And at school, “moms and dads are the best advocates for the child,” Dr. Mansoor said.

    “We recommend the parents and the child take control of their allergy by being cautious and knowledgeable about the food they are eating,” Dr. Mansoor said.

    Management Tips for Parents

    Others suggestions for parents of kids with food allergies:
    • Closely monitor your child and have injectable epinephrine available at all times, do not leave at home or in the car
    • Carry your child’s food allergy action plan, provided by their allergist to tell you when and for what symptoms to give the epinephrine
    • Don’t delay giving the epinephrine because it’s a life-saving medication with few side effects
    • Take along an antihistamine used to treat allergies in case reaction is very mild. Again, follow the food allergy action plan

    Friday, December 5, 2014

    Get Psyched Friday: Is it Anxiety or Acting Out?

    In her latest Get Psyched Friday post, psychologist Eleanor Mackey, PhD, explains how anxiety can make children retreat or act out – and how parents can help prevent these disruptive or out-of-control behaviors.

    We can all think of the “anxious” child and imagine the child who retreats into a corner, won’t speak when spoken to, and cries when separated from his or her parent. As one of the most common disorders of childhood, anxiety can often look just like this description for many kids. Transitions can be difficult, new situations intolerable, and specific fears paralyzing. These children are at high risk for difficulties throughout their lives if their anxiety is not treated.

    However, there is another group of children suffering from anxiety who often get overlooked or misdiagnosed. These are the kids who act out as a result of their anxiety, rather than withdraw. It partly comes down to a biological mechanism. We’re wired, in the face of danger, for either “fight” or “flight.” The “typical” anxious child goes the “flight” route, but there are many whose brains predispose them to “fight” when threatened.

    So, what does this look like?
    • Kids who present less typical symptoms of anxiety may be particularly sensitive to criticism and fight back when corrected.
    • When they go into a new situation or aren’t sure how to act around a peer, they might start getting silly, act out, or have trouble controlling their emotions.
    • These children tend to have more temper tantrums, particularly in stressful situations, including when demands on their behavior are high, when they are around new people, or when being asked to go to bed, especially if this is something they fear.
    Acting Out vs. Anxiety

    When children present less typical symptoms of anxiety, parents and teachers can often mistake their behavior as “acting out” or “behaving badly.” A parent or teacher’s automatic response is to be very firm and correct the behavior, enacting punishments or consequences.

    Although this response may work well for a child without anxiety, it could make the problem worse if a child is suffering from anxiety. Additionally, when a child does not get help with their anxiety and therefore the problems tend to escalate.

    What Can Parents Do?

    If you have a child who displays these disruptive or out-of-control behaviors in a number of situations, and it hasn’t improved, it is important to get your child assessed by a mental health professional and ask specifically about anxiety.

    This is especially true if you have a family history of anxiety, as this is a genetic illness. If we can identify children who would benefit from treatment for anxiety, we can prevent more difficulties as they grow up.

    Related Resources:

    Wednesday, December 3, 2014

    Gluten-Free Peppermint Patties

    Preparation time: 45 minutes

    • ½ cup coconut oil 
    • ¼  cup agave nectar
    • ½ teaspoon peppermint oil
    • ¾ cup dark chocolate chips
    • In a small bowl, combine coconut oil, agave and peppermint oil, mixing with a spoon.
    • Smash clumps of coconut oil against the side of bowl until the mixture is smooth.
    • Freeze mixture for a few minutes until it starts to harden, then remove from freezer.
    • Use an ice cream scoop to measure out little balls onto a wax paper-lined plate.
    • Place the plate in the freezer to firm up the mint balls. When they are firm, remove from the freezer.
    • Squish balls down into flat little patties on wax paper.
    • Heat the chocolate chips in a bowl until melted.
    • Dip the patties into the melted chocolate with a spoon.
    • Place the patties on wax paper to harden for about 10 minutes.
    Serves: 6