Parenting

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Get Rid Of Constipation In Children

Children's legs hanging down from a chamber-potConstipation is really, very truly, no fun for anyone. No fun for baby or child, no fun for the parent who worries and watches and cleans the clogged toilet, and clearly nothing wonderful for the sister or brother who waits while a family supports a child in the room next door. In general, constipation is a frustrating, sometimes hugely embarrassing, and often a chronic problem for young children. In my experience, parents worry a lot about hard infant or toddler poop in the diaper (goal is always peanut butter consistency or softer) but it’s when constipation sneaks up on many families in school-aged children that BIG suffering ensues.

I can’t say this loud enough: if you’re worried about constipation in your child do consider seeing your pediatrician, nurse, family doc or physician assistant to make a long-term plan. Constipation DOES get better but do know it’s over weeks to months. When your child’s intestinal tubing is stretched out for weeks it takes weeks to re-configure sometimes — quick fixes won’t be long term solutions. More below on which remedies to use and how.

Constipation sneaks up because after children are toilet trained and wiping themselves (around age 4 or 5) many parents no longer gaze in the toilet bowl so gone are the days of tracking daily poops. Before you reach for OTC medications, consider what is normal and what is not normal when it comes to poop (below). I usually break this down for children (and parents) in visual terms. I talk about things you find outside:

In general, poop in the toilet can look like a pond, a snakea log, or a pebble. When it comes to poop, we’re always looking for snakes. It seems to me that framed this way, school age children can do a better job knowing if they’re constipated or not. We’re looking for  Snakes in the Lake, people! Frame it this way with your child and perhaps they will be more likely to get a glimpse of what they produce in the toilet? Or at least a report?

Lots of foods, hydration and OTC medicines can quickly change the game with constipation. Before I detail more specifics on constipation and highlight some remedies, I do want to call attention to some potential concerns of polyethylene glycol (PEG 3350). The medicine PEG 3350 is an odorless, tasteless laxative that can be easily diluted in juice or water. It’s a big polymer and can’t be absorbed by the intestine so it works by binding to water so that water ingested can’t leave the intestines, colon, and rectum. The great news is it doesn’t cause cramping or more pain and isn’t addictive. Used daily (often for days or weeks) the powder binds to water and disallows the colon to dehydrate the poop so it just doesn’t get hard. Therefore the poop that comes out is soft and often helps produce less painful pooping — and often it comes out more often! It’s commonly sold under both brand (Miralax) and various generic names. However, the Food and Drug Administration (FDA) has only approved its use in adults, not children. Currently, PEG 3350 is being studied as well as the bi-products of PEG 3350, specifically ethylene glycol (EG) and diethylene glycol (DEG), to determine whether it might be absorbed by children and whether use of the laxatives is linked to development of psychiatric or neurodevelopmental problems. The New York Times has done 2 stories on this topic: one in 2012 and one more recently in 2015, both worth a read if you are debating giving your child PEG3350. For children and families with severe constipation often the benefits of using it far outweigh the concerns.

What Is Constipation And Why?

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Teens Use Cough Medication To Get High

sma-cough-syrup-medicine-bottle-with-icon

We’re thankfully in the middle of a national conversation about ways to protect the public from drugs of abuse. The opioid epidemic has brought the issue of medicines and risk to the forefront and has awakened a new understanding about the lethality of drugs of abuse and addiction. There are other medicines, even over-the-counter medicines, that are used recreationally and can be risky, too. This can be especially true with children and teens. Enter cough medicines…

Data shows approximately 1 in 30 teens, or approximately one child in every high school class math class, has abused over-the-counter (OTC) cough medicine to get high. Typically teens use DXM — dextromethorphan when looking to get high. I’m partnering with the Stop Medicine Abuse campaign to spread the word among parents. Have you seen this “PARENTS” icon on cough and cold medicine packaging lately? It’s there to raise awareness of medicines that contain dextromethorphan (DXM). Look for the icon when making purchases and think through some safe storage tactics if you purchase medicines with the label or already have products within your home.

  1. Monitor Your Medicine Cabinet: Take steps to protect your teens by safeguarding all the medicines you have in your home that could be abused. Know what you have and how much, so you will know if anything goes missing.
  2. Monitor Your Teen: Be aware of what your teen does online, the websites they visit and the amount of time they are logged on. Ask them. There are many websites and online communities promoting DXM abuse with instructions on how to achieve certain levels of highs. If you see the sites in your browser’s cache it’s worth your while to check in. Teens are less likely to use alcohol or even drugs of abuse if they know risks and that their parents disapprove. Let it be known what you know!

Facts On DXM Abuse In Teens:

  • DXM is an active ingredient found in over 100 cough and cold medicines. Used appropriately, it is a safe medicine that alleviates coughs in children older than 4 years of age.
  • Abuse: Approximately 1 in 30 teens have abused cough medicine to get high, and 1 in 3 teens in grades 9-12 knows someone who has abused cough medicine to get high. Ask your teen what they know. Without judgment provide information about risks of using cough medicine to get high. Judgment can be stifling; information and guidance is love.
  • Available: Teens may feel it is harder to get their hands on it as teen perception of access has gone down 24 percent. In 2010, 65% of teens agreed that DXM was “very/fairly easy to get.” That number has since gone down to 41% in the last few years.
  • What Does It Do? Taken in excessive doses, DXM has intoxicating, disassociative, and psychoactive properties. This means cough medicines taken in excess can potentially really change the way a teen thinks. The most common side effects include: vomiting, rapid heartbeat, and loss of motor control.
  • How Much? Teens report taking up to 25 times or more of the recommended dose of cough medicine to get high. Side effects from abuse include nausea and vomiting, distortions of color and sound, hallucinations, and loss of motor control.
  • Dangerous when combined: DXM is more dangerous when combined with other substances (other drugs and alcohol). Risks elevate with multiple substances and side effects can even be lethal. Tell teens this so they know the serious risks when mixing medicines/drugs. Make sure every teen knows they can always call Poison Control and get help immediately if they need it — safe and won’t get them into trouble. Ever. Just a team of people who want to help if they are ever worried about an ingestion or an ingestion in someone they know. Put it in your teen’s phone today: 1-800-222-1222.
  • No question that what parents say matters. Teens who learn a lot about the risks of drugs from their parents are 50% less likely to use drugs. True.

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Empathy And Compassion For Transgender and Gender Non-conforming Children and Teens

gender-bathroomI saw this bathroom sign in my sons’ school a week ago. Talk about inclusion. I’m not only pleased that my boys are being exposed to open inclusion, I’m delighted they are getting the message that they can be whoever they are at home and at school. NO question in my mind the data proves if a child, teen or adult has questions about their gender their life is at risk for being harder. This is manifest in the high rates of anxiety and depression, bullying and ridicule, and feelings of isolation in those who are gender non-conforming and transgender. This is only estimated to be about 1% of the population (numbers are imprecise as many people hide this challenge) but how we all support those who question their gender matters for us all, the 99% of us who don’t have this challenge.

We must have compassion and empathy for children and teens who are transgender and gender non-conforming. We must accept children and teens and their families, and we can connect children and families who struggle with resources (below).

Children Are Born With Gender, Parenting Has Little To Do With It

  • Research shows that gender is established at birth. That means children are often born knowing if they are a boy or a girl irregardless of their sex (the chromosomes/genes that determine their body’s appearance and sexual characteristics). Sometimes children know this early, sometimes later in life.
  • Research shows that there is no evidence that parenting is responsible for a child having a different gender than their sex. Meaning — parents don’t have control, with their actions, over their child’s gender. They can’t change a child’s gender.
  • Research shows that children are less likely to end their life when they have challenges with their gender identity if they are accepted by their families. This means children who grow up in homes who accept them are less likely to suffer. Maybe a no-duh, but it’s something all parents should know.

This is complicated stuff, of course, and isn’t the same for all children and teens. Some children question their gender early in life (as early as preschool years) and will traverse childhood knowing they are transgender while other teens may find out at the onset of puberty that something isn’t quite right. Some children or teens just don’t identify with one gender or another (gender non-conforming). When they question this, we want to make sure they get what they need.

The most important message is that we must be open to what children express, connect children, teens and families with resources they need, and be aware of the risks for suffering in children who question their gender. Thankfully, there are lots of people to help and resources. Seattle Children’s Hospital now offers a specific clinic to support transgender and gender non-conforming children and teens (age 8-21 years). Experts and staff provide support for puberty blocking (stopping onset of pubertal development) or hormone therapy (hormones to have body characteristics match gender). They can also support conversations and planning for those who want to transition.

Statistics & Risks For Transgender Children And Teens

  • Transgender population is hard to define, probably less than 1% of adolescents
  • All gender non-conforming are at increased risk for bullying, anxiety, depression & suicide
  • 71% of transgender people said they hid their gender or gender transition to try to avoid discrimination

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When Is It ADHD In A Child?

I talked with Erin Schoenfelder, PhD,a specialist in ADHD and Director of Behavioral Treatment at the PEARL Clinic (Program to Enhance Attention, Regulation & Learning) here at Seattle Children’s Hospital, about ways to recognize ADHD in children and teens. The previous post we shared included the acknowledgment that it may be harder to parent a child with ADHD and provided reasons for it along with 5 tips to help parents and families. In the podcast above, Dr. Schoenfelder helps parents, teachers, and pediatricians understand what ADHD is and identifies ways to support, diagnose, and evaluate children with whom parents and teacher hold concern. First and foremost make sure you understand how a child sleeps before doing any further work-ups! Sleep challenges can be a big mimicker of ADHD as deprivation causes inattention and distractibility.

What is ADHD?

  • Developmentally atypical symptoms of inattention and/or hyperactivity/impulsivity.
  • Developmental disorder that persists over time and years and is consistent across settings (i.e. children have challenges at school, at home, during sports activities, at a synagogue or church).

Signs, Symptoms, Red Flags

  • Problems in multiple settings completing work, getting along with others, following directions, and succeeding
  • Teacher noticing the child is standing out from others
  • Child an outlier in a group – soccer practice, birthday parties, home
  • Risky behavior, getting injured due to impulsivity
  • Falling behind in learning due to off-task behavior

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3 Reasons And 5 Tips For Parenting A Child With ADHD

Turns out that in clinical practice I’ve learned that it’s okay to acknowledge that some children are simply harder to parent than others. From what I can tell it’s really true. Often those parents struggling with children with behavioral challenges blame themselves more than is necessary. Sometimes rationale for why it’s harder helps.

There are all sorts of reasons for increased challenge. Chronic or challenging underlying illness, mental health struggles, and/or behavior challenges are a few of the reasons that some parents have a much harder job. I talked with Erin Schoenfelder, Ph.D. a specialist in ADHD and Director of Behavioral Treatment at the PEARL Clinic (Program to Enhance Attention, Regulation & Learning) here at Seattle Children’s Hospital about how parents often NEED a different parenting strategy if their child has ADHD. She outlines it beautifully in the podcast. These 3 reasons and these 5 strategies Dr. Schoenfelder shares can help families support children with the unique challenges that come along with ADHD.

Why do children with ADHD need different parenting strategies?

Normal good parenting strategies (sticker charts, send to room, natural consequences) don’t seem to work for kids with ADHD. Parents need additional strategies. When children with ADHD fail to thrive in typical structures for reinforcement, it doesn’t mean parents are failing. Parenting a child with ADHD can at times be harder than parenting a child without attention challenges.

1. Children may lack internal “self regulation”

  • Kids not regulating their own engines to stay on track. So children with ADHD may be very susceptible to external environments, including distractions, inconsistencies.
  • Therefore, behavior is inconsistent. Kids aren’t able to do what they know how to do.

2. Limited window on time for discipline

  • “Now” versus “Not Now.” Make sure you provide immediate feedback for children with ADHD. If you wait, it may lose relevance or even be lost in the memory bank.
  • Children with ADHD may have a tendency to have their window get “flooded” easily, and they cannot shift forward to predict what will happen next, or backwards to recall what has/hasn’t worked in the past.
  • Children don’t connect behavior and consequence the same way as children without ADHD.

3. Children with ADHD may have different processing of rewards

  • Dopamine is processed differently in the brain of children with ADHD. Therefore when they get the chemical kick of reward, they may experience it differently.
  • Everyday things feel less rewarding and interesting than they are for other kids.
  • Other things (screens) may feel SUPER rewarding…

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How To Dose OTC Medicines In Babies

kyotcs_feverinfographic_weightageAbout 4 million sweet babies are born in the U.S. every year. And since September & October are two of the most popular months in the year for the birth of babies I’m taking a moment to share a couple of reminders for new families and those of you who support them.

1. Nursing Moms & Over The Counter (OTC) Medications: Every new parent feels a sense of overwhelm and exhaustion after welcoming a new baby. It can be especially exhausting when moms are breastfeeding and carry the new concerns about what they’re eating, how they’re both supporting themselves and their baby’s milk and when moms and dads have concerns about passing OTC medications (or Rx ones) through mom’s milk. Here are a few guidelines and reminders:

  • Don’t take aspirin if you’re breastfeeding.
  • It’s always best to avoid extra strength formulas of any medication, as they stay in the blood stream longer.
  • Always ask your doctor if you are worried or have questions about a medicine or supplement you’re taking if you’re breastfeeding. Always makes sense to ask.
  • Read the Drug Facts label as this will sometimes help you understand risks.
  • I like LactMed as a resource/search tool to help find information on medications. LactMed is updated monthly and is a database of over 1,000 drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects on the nursing infant. All data are derived from the scientific literature and fully referenced.

2. When Your New Baby Gets A Cold Or Fever: Your baby’s first bout with a cold or fever can leave you feeling scared (and exhausted) as you watch your baby deal with the inconvenience of mucus and snot, coughs and/or sneezes. Infants are more susceptible to infections because they don’t have fully developed immune systems hence why we all work hard to avoid exposures for them early in life. But upper respiratory infections (“colds”) do happen even with the best of protections.

Oral cough and cold medicines (including cough suppressants, cough expectorants and multi-symptom cold medicines) are not safe for infants and young children under the age of 4 or 6 years of age.

However, if your baby has a fever and is OVER the age of 3 months, you can give them acetaminophen to help relieve symptoms. The label on OTC medicines for infants and children only includes dosing for children age 2 and older; so talk to your doctor for dosing for younger children.

Always dose medicine by your infant’s weight, not their age, so at every well child check-up as your baby grows, ask your pediatrician to provide the proper, current dose for OTC medicines.

You can also give your child ibuprofen for mild infections, fever, or teething. Dosing for children 6 months and older is on the label; talk to a doctor for dosing for younger children although it is not typically recommended. Here’s more on dosing acetaminophen and ibuprofen by weight in infants and toddlers.

There are also several non-medicine interventions for colds. If your infant or toddler is too young to be given OTC medications or you’d prefer not to use them, there are other options to help relieve symptoms and keep your baby sleeping and comfortable. Read full post »

Playing Multiple Sports Is Better For Most Children

New data out (that I happen to LOVE) seems to go against many parental instincts, including a few of my own. I think plenty of parents have been led to believe in the last few decades that specialization and mastery in a single sport early in life is GOOD for their children. Some of that instinct rises from our guts in the mis-appointed “10,000 hours rule.” The idea that once our children do something for 10,000 hours they will be an expert. The 10,000 hour rule (brought to masses in part via Malcolm Gladwell) suggests that with dedication and time (10,000 hours) a person will develop mastery over a sport or skill. A recent American Academy of Pediatrics clinical report states, “it has often been misquoted that to succeed, an athlete needs to have 10,000 hours of practice/competition over 10 years. The media have incorrectly extrapolated Ericsson and co-workers’ studies of chess players to a formula for sports success. Many examples exist of successful athletes who have <10,000 hours and others who have not succeeded despite having >10,000 hours of practice/competition.”

Children in sports have changed over the last 40 years.

There is increased pressure to participate at a high level, to specialize in 1 sport early, and to play year-round, often on multiple teams. This increased emphasis on sports specialization has led to an increase in overuse injuries, overtraining, and burnout. ~Dr. Joel S. Brenner

And it’s just not true that grunt hours in a single sport will make champions of all of our children. Worse — focusing early and often on one single sport may lead to overuse injuries, burnout, isolation, and a less likely shot at succeeding at and loving sports for a lifetime.

overuse-injuries-1

I think in the time of the tech boom we can also be led astray by the “Zuckerberg effect”  — the idea that we can only really change the world by focusing on a single thing and becoming a global master in doing so.

Reality is, those children who specialize in a single sport early are at higher risk for overuse injuries, burnout, quitting sports altogether and even isolation and loneliness. Successful, even elite athletes, are more likely to develop when our children don’t specialize in a single sport until late puberty, around age 15 or 16 years.  Read full post »

For The Sake Of Privacy: Just Some Of The 20 Questions

img_9254This year, for the first time, I did the annual 20 questions (see below) with the boys at the start of school and realized that I couldn’t share all of the responses here. Just too personal, just too vulnerable, just too real. Sharing all of the answers they entrusted with me would somehow expose them. At some point, every “mommy blogger” censors and protects her children and I, of course, have been doing that since day one. But with these, even somewhat impersonal questions, I felt the exposure and raw responses more than ever. No way that I want to exhume vulnerability that the boys don’t need the world to hold…

Some moms cross over into the abyss of online oversharing with their children’s lives (I hope I won’t but life is clearly a work in progress). This mom wrote recently about over-sharing as a blogger and how it was her own father who stepped in to “Lion Grandpa” (I’m using that as a verb) for his grandson saying “enough is enough” when the mom discussed signs of his first pubertal change online. She pivoted and retreated from her raw content online and has decided to stop writing about rearing her children. Each year I write less and less about the boys and as time has unfolded I’ve taken to asking them before sharing.

There are about 200 bajillion blog posts about the challenges of “sharenting” online and blogging about children and/or the industry of moms who leverage their parenting experience in their work. No question that when it comes to sharing publicly, everybody has their own unique fingerprint of what lines exist and what lines we won’t cross. The decade (+) of blogging has clearly connected us; stories that detail intimate narratives about life and love and passion and failure and intent really do sew us together while being alive. This may be especially true in the isolation and rigors, doubts and overwhelm, and abundant joy that comes while raising children.

So to these 20 questions — the blog post has historically, around here, been a hoot for the boys. They do LOVE to be interviewed. We’ve used the interview as a benchmark into the annual unfurling of time. We have enjoyed the pool of reflection it’s given as the boys navigate concrete responses and loyalties of colors and airplanes to the progression in dreaming about the future. No question it’s fun to think about the 2012 responses and how they compare to today’s — I mean, these little boys really are growing up. Here’s the 2013 (includes 2012 responses) & the 2015 posts.

These boys are still just as sweet and innocent when they respond to the questions (developed when they were in preschool) but their reflections seem to swell now past the margins of the question and into the souls of who they are working to become. Lucky, lucky, lucky, lucky me. May you, too, have a series of questions you ask each year that you write down. Next year I’m editing them and adjusting for age and we’ll see just what renders into shareable — who knows! Until then, enjoy the silliness…

Most Of The 20 Questions At The Start Of School

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Reducing Back To School Stress In 12 Minutes

I find the back-to-school time period to be a little bit stressful (hellowwww, understatement) and perhaps even anxiety inducing. Even good transitions rack up stress. As we brace for the holiday weekend and expect the onslaught of school in earnest while September unfolds, I suggest we can decrease the stress with a bit of info. Here’s my 12-minute podcast to support you as you send your kids back to school and set them up for an awesome start. We’re all hoping for a healthy, safe fall. Take a listen…it won’t take long and you may find yourself a little more relaxed and ready for the chaos. Immunizations, sleep, anxiety and tips for transitions!

Tips For Getting Sleep Schedules Ready For School:

  • Timing: Shift slowly and get started now. If bedtime has migrated to 10pm, for example, and you’re hoping to have your kids sleeping by 8pm for school, start now. Move bedtime forward about 30 minutes every 3 to 4 days.
  • Screens (this isn’t new, I know): Screens, using them and exposing ourselves to the light they emit, impairs our natural sleep hormone melatonin from rising and helping our brain drift off to sleep. Have all screens, tablets, phones, and laptops transition back to sleeping in the kitchen (not at the bedside). In minimum, turn off screens at least 1 hour before desired bedtime!
  • Sleep As Health: getting sufficient sleep contributes to improved attention, safer driving, less health risks, and a more steady mood. We’re nicer when we sleep! It also contributes to how we think on life and even how we remember events; when we don’t sleep we tend to remember things in more somber light. Getting enough sleep supports a healthier life and I would suggest an even happier one. Quick reminder: school-aged children need 9 to 11 hours of sleep and teens need 8 1/2 to 9 1/2 hours. Really!

 

6 Ways To Help An Anxious Child

No question it’s tough to keep our cool when our children are unraveling. It’s especially a challenge when our children are rattled and over-run with anxiety. I partner with parents on a weekly basis who feel their children are anxious. All of us want support in knowing just what TO DO in helping our children thrive while also not letting them suffer.

I partnered with Dr. Kathy Melman on the podcast to review tips and strategies for parenting when children are anxious or when our children suffer from anxiety. Dr. Melman is wonderfully steady and clear in knowing what we can do when we find ourselves amid a sea of anxiety. Dr. Melman explains how to improve the environment for our children, what we can do for ourselves as parents to protect our children, and how to help our children not only cope but thrive in the face of anxiety, disruption, fear, and challenge. Listen in and read her 6 tips below. Number four is a BIGGIE…

6 ways to Help Your Anxious Child:

  1. Modeling Matters: If a parent struggles with anxiety—get evidence based cognitive behavioral therapy (CBT) treatment with an adult anxiety specialist. Caring for your own anxiety will limit how your child models undesired behaviors.
  2. Intervene early and effectively! If your child shows signs of anxiety that is causing distress and/or interfering with functioning, seek CBT treatment with a child anxiety specialist. Don’t wait years for help because untreated anxiety can lead to problems including possible school refusal, lack of friends and opportunities to develop social skills, limited development of independence, healthy sleep patterns, lack of involvement in activities outside of the home, substance use and depression as one’s life shrinks with loneliness, low self esteem (“I can’t handle this”) and lack of building mastery. Anxious children often don’t get the help they need and when they do, they have often already suffered for years, other problems have developed, and they often don’t get the most effective, evidence based behavioral treatment.
  3. Acceptance and Empathy: Accept if your child is “wired together” to have more anxiety and be empathic, rather than invalidating, of their experience. Taking the moment to accept their feelings (even when they seem outlandish!) will allow you to both acknowledge and then support your child more effectively.
  4. Don’t Permit Avoidance: It is really hard to see your child suffer and parents often, meaning well, allow their child to escape and avoid anxiety provoking situations. As a parent, it is important to learn to tolerate this distress, remain calm and know that permitting escape and avoidance and providing excessive reassurance only strengthens anxiety, reinforces your child’s thoughts that the world is a scary place and the belief that they aren’t capable of coping effectively. This is an important dance parents often do with their anxious children and it is critical to change this pattern.
  5. Reward Brave Behavior: Instead of paying attention to anxious behavior, reward use of anxiety management skills (recognizing when anxious, which situations trigger anxiety, what happens in your body, what are your thoughts, calming your body, challenging unrealistic, catastrophic thinking with checking the facts to develop more realistic thinking along with coping and calming thoughts, and approach feared situations in a gradual, manageable, step by step fashion). We are asking our children to do what terrifies them so provide them with empathy, support, skills and coaching so they overcome anxiety by facing their fears and learning that they can, in fact, do this, nothing terrible will happen, and they can live a full life that is not limited by anxiety. Rewarding use of skills and facing fears (known as exposure) helps your child do what is challenging. Exposure is the most important ingredient in effective treatment of anxiety.
  6. Be Involved in your Child’s CBT Anxiety Treatment: Parental involvement is critical for many reasons including learning about anxiety disorders and their treatment, learning which parenting strategies increase and which decrease child anxiety, learning to coach your child in use of anxiety management skills in challenging moments, not permitting the dance of avoidance, modeling use of skills and brave behavior, learning to tolerate when your child is experiencing distress and responding with empathy and approach, providing many opportunities for exposures and rewarding brave behavior. Parents can also use their understanding of anxiety disorders and their effective treatment to communicate important information with schools, coaches, grandparents and other involved caregivers and settings.