Constipation is really no fun for anyone. No fun for baby or child, no fun for the parent who cleans the clogged toilet, no fun for the sister or brother who waits while someone works on solving the problem in the room next door. In general, constipation is a frustrating, sometimes embarrassing, and often chronic problem for young children. Here are a few ideas to get rid of the no-fun part and ways to protect your children, support them positively, and avoid dangers that can rarely come from over-the-counter (OTC) medications.
Before you reach for OTC medications, consider what is normal and what is not normal when it comes to poop. 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 snake, a 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?
In my experience, parents worry a lot about hard infant or toddler poop in the diaper but constipation sneaks up on many families to school-aged children. After children are toilet trained and wiping themselves (around age 4 or 5) many parents no longer gaze in the toilet bowl. Long gone are the days of staring at every diaper as parents lose track of the daily poops, how often they poop, and how a child feels when pooping. But first, some definitions: Read full post »
A new observational study illuminates some ugly truths about parental/caregiver use of cell phones and smartphones at the dinner table. More than anything else, the observations serve up a hearty reminder that cell phones are embedded into our lives (see my son’s “Lego iPhone” as case in point) and that we have to be diligent in making digital breaks a habit. As phones and devices get more useful, they become harder and harder from which to separate.
Reading the new study I felt a little queasy for two reasons.
ONE: there are moments I fail my children in this regard. I think you’re fooling yourself if you don’t think you are (if you own a cell phone, smartphone, tablet, or computer). I would suspect most parents who read the study see a bit of themselves in there. I certainly remember (vividly) the day that my then 3 year-old son wanted my attention while I was working on my phone. He must have asked and gotten no response. He then literally put his head between my cell phone and my face to get my attention. Talk about a wake-up call…
TWO: I really hate to read about children becoming either helpless and/or giving up on trying for their parents’ attention (this was observed in the study). I also hated reading about children who kept vying for their parents attention and then get shot down and yelled at for interrupting. Just so unfair to children during dinner. Parenting really is different now. We weren’t raised by parents with these distractions. The implications on our children’s (and our own) health are just starting to to come into focus.
We’re all vying for a sane balance with our digital devices. The study detailed below offers up some uncomfortable observations and fuel to make changes now:
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New 2014 recommendations are out for improving our prevention efforts for children. Parents can help ensure children get what they deserve at check ups. The updates to recommendations for wellness check-up are written to guide physicians but parents are a key voice in ensuring it all happens!
Updated 2014 Recommendations For Check-Ups
Some relevant changes to prevention/screening for children:
- Infants: All infants need a pulse oximetry screen at or after 1 day of life to screen for heart defects. The test is non-invasive (just requires a technician, nurse, or doctor put an oxygen probe on their arms and legs). More information on the test here. Ideal time for testing is between 24 and 48 hours of life. If your baby is born at home or outside the hospital, go in to see pediatrician for the screen on day 1 or 2! Toddlers should be screened for iron deficiency risk at 15 and 30 months of age.
- Children: All children should be screened for depression every single year starting at age 11 years. Don’t ever shy away from discussions about mood with your pediatrician. In addition, all children are recommended to have cholesterol screening at age 9-11. I reviewed ways to prevent heart disease and cholesterol screening policy statement here.
- Teens: All teens need an annual check-up (a complete check-up will provide some time alone with doctor and nurse; mom or dad will be asked to leave for at least part of the visit). All teens need HIV screening test at age 16-18 (or sooner) and girls get their first pap smear at age 21.
5 Things Parents Need To Know About Check-Ups
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New data published in JAMA today finds that there has been no significant change in rates of overweight/obesity overall for children between age 2 to 19 years of age since 2003. This is unfortunate news in the big fight against overweight and obesity. Conclusions from the study, “Obesity prevalence remains high and thus it is important to continue surveillance.” Obesity rates remain high at with 17% of children and more than 1/3 of adults.
The good news is that there was improvement in one small group, toddlers age 2 to 5. Numbers from National Health and Nutrition Examination Survey(NHANES) show reductions in overweight and obesity for the preschoolers by as much as 43% during the last decade. Really hoping this is a canary in a coal mine situation — perhaps they’re chirping a clue. Learning the “why” behind the reduction in obesity for preschoolers feels like a huge opportunity. However for the mass of people researched in total (over 9,000 from birth to age > 60 years) the data confirms we’re not done tipping the scales.
The research article evaluated rates of overweight and obesity between 2003-04 NHANES data and 2011-12 data on children and adults. The CDC is highlighting the success in the toddlers, stating:
While the precise reasons for the decline in obesity among 2 to 5 year olds are not clear, many child care centers have started to improve their nutrition and physical activity standards over the past few years. In addition, CDC data show decreases in consumption of sugar-sweetened beverages among youth in recent years. Another possible factor might be the improvement in breastfeeding rates in the United States, which is beneficial to staving off obesity in breastfed children.
It’s wonderful to see signs of improvement in the small population of children included in the NHANES data but this research article doesn’t investigate how the improvements were made and/if they are stable. More research will have to unfold. We’re all desperate — parents, pediatricians, public health experts — for solutions that work in not only curbing, but reversing the rates of overweight and obesity. This data can potentially focus the light on where we need to look to study cause and effect to determine possible success stories and strategies. Five quick tips for parents now: Read full post »
Consistency may be the “secret sauce” in parenthood. Anything from helping children survive temper tantrums to helping your children eat more diverse foods, providing consistency with expectations and daily routines may be the very special thing we do that allows our children to thrive. Like most challenges in life, talking about and identifying the need for consistency is easy, implementing it throughout our daily lives is much more of a challenge. Finding and securing a consistent bedtime is one place where this “secret sauce” may really work. New data on sleep patterns for young children drives this point home. Getting your children to bed at the same time each night is powerful.
A study out today in Pediatrics evaluated data from over 10,000 children in the UK. As a part of a larger study (UK Millennium Cohort Study) researchers collected bedtime data at age 3, 5, and 7 years for children. They found children with nonregular bedtimes had more behavioral difficulties. Further, as children progressed through childhood there was incremental worsening in children’s behavior scores as they were exposed to more and more inconsistent bedtimes. Read full post »
It’s the first day of school for us today. This time of year is momentous.
The photostream on Facebook this morning is striking: children in pressed shirts with clean backpacks. It’s obvious the cameraman for each photo is smiling, just so much pride… There is something clearly resonant with we adults about a clean slate, a new day, a first moment of each new grade level. We have our memories tucked neatly into our pockets (yes, I know my 1st grade teacher’s name) and this first day often represents an important line in the sand. First day of school is clean, hopeful, and sincerely wondrous for most. I told someone yesterday I’d move a mountain to be present for first day drop-off.
I know today is also complicated for some parents. Not everyone can get time away from work for the drop-off at school or the bus pick-up. Some parents have doctor’s appointments or illness that prevents an easy morning and send-off. Nearly 1 out of 10 children are living with their grandparents. So today isn’t all white-picket-fence-two-parents-at-the-door perfect for all children in the US. But for most, it’s a very exciting transition.
I also know amidst the sparkle of the fresh start today we have to remember that the beginning of anything does come with significant anxiety for many children and teens (and their parents). The rapid ramp-up to full speed this week required by early start times and homework schedules with afternoon +/- sports practice can incite anxiety and real fatigue for children, especially those with social phobia, underlying anxiety, depression, or learning challenges. Here are a few quick reminders that may ease the September transition for us all.
4 Tips When Starting School
Sleep is essential.
- Preschoolers: 10-12 hours of total sleep (night time sleep + naps). Most children naturally get tired and ready for bed between 7pm and 9pm at night. Most 4 year-old phase out their nap prior to turning 5.
- School-age children: 10-11 hours total sleep. Most children get to bed around 8pm but as they near age 12, they may naturally “phase shift” later into the night. That means as they age and go through puberty, many tweens aren’t really tired until around 9pm or 10pm. Puberty brings on changes to their sleep cycle and thus shifts them later.
- 12 year-old to teens: 8 1/2-9 1/2 hours total sleep. Read full post »
Our 4 year-old swam across the pool this past weekend for the first time. After years of swimming lessons this was a reason to celebrate: big throw! I hate to admit it but I’ve really disliked doing swimming lessons. Both boys often brought more tantrum and tears than tangible joy to the pool deck. After a day at work I would often leave evening swim lessons embarrassed, exhausted, or somewhat disappointed. They felt like #fails. So when we got across the pool this past weekend, we were all delighted. Finally the big win.
Swimming across the pool doesn’t mean I’m off the hook, of course.
I will say, however, that eating those veggies has paid off. Now that we’re finally swimming I’m thrilled we did lessons early. There is a lot more both our boys still need to learn about water safety and skills they’ll both need to be strong swimmers. For example it’s much harder for them to swim in the lake than the pool secondary to the waves and distractions. They still don’t understand risks of the water. So we have years of swimming lessons ahead but I’m feeling optimistic with the epic win last Sunday.
New data published in the last few years encourages swimming lessons earlier, as early as age 1 to 4 years. Data finds early swimming lessons reduce drowning risk in those children most at risk–toddlers (especially boys). Although swim lessons are never a replacement for close supervision, there may be some protection against drowning when children get started early. The American Academy of Pediatrics (AAP) says this about early swim lessons: Read full post »
Juice is never necessary is a child’s diet. Unpopular as this is to say, juice is always an extra, add-on, treat-type part of what children should eat. High in sugar and low in nutrition, excess juice in a child’s diet is linked to poor nutrition, obesity, and dental cavities. Although 100% juice comes from fruit, after it’s smooshed and pushed through machines to produce clear juice it’s separated from much of the health benefits (fiber) from whole fruit.
Late last week the FDA provided an updated “action plan” and recommendation for monitoring inorganic arsenic levels in apple juice. Back in 2011, the controversy about arsenic in apple juice began when Dr Oz presented data on his afternoon television show that was quickly rebutted by Dr Richard Besser on Good Morning America. Dr Oz reported high levels of total arsenic (organic and inorganic) in apple juice but there were concerns of unnecessary scares. Up until this point, the FDA wasn’t mandating arsenic levels in apple juice. After a cascading series of events (much criticism and then more reports and analytics) it is now more widely accepted that up to 10% of apple juice may have higher levels of inorganic arsenic than we tolerate in drinking water. Inorganic arsenic consumption can damage organs in our body and in high quantities it’s linked to an elevated cancer risk. Organic arsenic isn’t harmful to our body (it passes right through) and is found naturally in many foods we eat like shellfish or seafood.
Consequently, the FDA has decided to decrease the level of inorganic arsenic they tolerate in commercial apple juice to that of levels acceptable in drinking water (10 parts per billion). Inorganic arsenic in our diet typically comes from food contaminated with and/or grown in soil with high levels of inorganic arsenic (animals fed food with arsenic or food grown in contaminated fields with heavy industrial products). In the past couple of years arsenic has enjoyed quite a bit of media spotlight, especially in light of evolving 2012 information about elevated arsenic levels in rice (cereal, noodles, white or brown organically grown or not). Because of this, most pediatricians now recommend offering infants rice cereal only once weekly. As with all concerns about the food we eat, moderation is key…5 tips: Read full post »
As we approach the 4th of July, a quick reminder about injuries and ways to protect your children. Each year, preventable injuries occur in young children and teens from fireworks. Children between the age of 5 and 14 are the highest risk for firework injuries—over double the risk of the rest of us. Serious injuries occur including devastating injuries to the eyes and face. Not surprisingly, the most common injuries are burns. Even sparklers can cause serious burns; sparklers burn at up to 2000 degrees, as hot as a blow torch and hot enough to melt some metals.
As you prepare for the long weekend and take time with your family and friends to celebrate the incredible freedom we enjoy here in the United States, make sure your family is safe if you choose to use fireworks. Remind teens about safe driving, avoiding alcohol on the road, and distractions. A crummy fact: the 4th of July ranks as the deadliest day of the year for teen drivers.
Tips And Facts For Preventing Family Firework Injuries:
- The most important (and likely most obvious) reminder is to never allow children to light or set-off fireworks. Injuries often occur when fireworks malfunction or are not set-off properly.
- Don’t use or ignite homemade fireworks. All 6 firework-related deaths in 2012 in the United States occurred secondary to use of illegal or homemade fireworks.
- If you think you’re too smart for injuries on the Fourth of July, hold on a second. Recent research found that higher levels of education do not protect against firework-related injuries.
- If you have fireworks in your backyard, make sure you have a garden hose and bucket of water ready and full while enjoying fireworks in case of any emergency or fire.
- Light fireworks one at a time, and move back quickly! Don’t ever allow your family members or friends to re-light a firework that didn’t go off properly or perform as expected.
- All ages considered (children and adults), 3/4 of firework burns and injuries occur in boys and men. Males are most injured from firecrackers, sparklers, bottle rockets, roman candles, and re-loadable shells.
- Here’s a complete, updated infographic from the Consumer Product Safety Commission about firework injuries and source of the drawing included here!
Last day of school this week. The backpack is nearly as big as his body; that’s no optical illusion and the body-to-backpack proportionality serves up a dutiful reminder for me that my little boy is still small. To me it feels like he’s perfectly diminutive amidst the big surroundings of his school– it’s boards and doors towering high enough to accommodate the 8th graders yet inclusive enough to welcome him gently into grade school.
It’s clear that as Kindergarten lands in the rear-view mirror my hearts aches. I know I’m supposed to celebrate his growth and accomplishment for finishing. And I do. Yet all I can think about today is the reality that now that he’s technically a first grader he is also a bona fide “school-aged boy.” In pediatrics that does mean something altogether different. In fact once a child is 6 years of age, we often tell families it’s fine to come in for well child care check-ups every other year, absent concerns, until a child is 11 years of age. Growth typically is steady and stable, children advance in school, and routines are made–this is “school-age.” Fortunately even though some of this time between 6 and 11 may be very routine, even in 1st grade, a friend reminded me last night, “They are still made to believe they are the center of the universe.”
Every parent ahead of us warns us about the speed of travel through parenthood. They reflect on the g-forces of time and the flash of light between Kindergarten and the day they find themselves standing in an archway with a mature child at the end of high school. Often those ahead of us couple the warning about the velocity with an instruction. “Savor this time,” they say. And so many of us do. We savor, we relish, we reflect, and we love. It isn’t always perfect and pretty, there are tantrums and accidents, mess-ups and failures, but we do savor and we really are present in the moment so often.
Sometimes I want to scream out that we parents (of young children) –we get it, too.
I’ll admit though that amidst the myriad of moments this past year that I have felt mindful and present, I’ve also had plenty of others where I lacked attention.
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