‘school-aged children’

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End Of School

Screen Shot 2013-06-13 at 3.40.58 PMLast 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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First Day Of School: 6 Tips For Sleep

We know children are sleeping less now than they did 30 years ago. Research studies are piling up that assimilate the ill effects of our lack of shut-eye. When children don’t get the sleep they need they suffer. And not only in the ways we may expect. Sure, they are grumpy and irritable but research also shows children who create a sleep debt also have a more difficult time completing school work, they don’t score as well on tests, they may be more distractible while having difficulty maintaining attention, and they may be at higher risk for having an unhealthy weight. Further, tired teens who are on the road driving in the early morning are at more risk for motor vehicle accidents. Data shows that more than 1/2 of all early morning accidents attributed to drowsiness occurred in drivers between 16 and 25 years of age.

Teens are potentially at the greatest risk for drowsiness because they tend to naturally fall asleep later and school start times get shifted earlier and earlier. Here in the Seattle area, many schools start at 7:30 am (school bell times). And multiple students in clinic this past week have shared with me that they are attending extra classes during “zero period” that begins at 6:30am! That means, many teens are responding to a 5:00am alarm clock. If these teens aren’t to bed until near-midnight, come October they are going be exhausted.

Typical Sleep Needs For Children And Teens

  • 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 8pmbut 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. Most teens aren’t tired until 9pm or later. To get the amount of sleep they need, you really have to help them prioritize bedtime. Between the lure of Facebook, the average of >100 text messages sent daily (!), and the academic demands of school, coupled with extra-curricular activities,  it can be tough. Learning to value sleep is life skill. If you’re having trouble getting these hours in, you’ll see your teen catch up on sleep during the weekend. This is sleep debt. They can fill the bank and replenish the sleep debt by sleeping in on weekends, but it’s imperfect. Allow them to sleep in, but help them also keep the same bedtime Friday and Saturday as best they can.

6 Tips To Help Your Child Prioritize Sleep For School

  1. Work to design and agree upon (as a family) a reasonable bed time for your child or teen. Eight o’clock for school age children and 9:30pm-10pm for teens may be most reasonable. Read full post »

First Day Of School: An Interview?

September is upon us. I’m back to blogging after my August pause. Life has been very busy and peppered with bits of flurry, but more on that later. School is about to start.

As we all return back to the routine of the fall and ready ourselves for winter, it’s a good time to check in on where we stand. This month really can feel like packing our cheeks with acorns. The transition to school brings on all sorts of stress, anxiety, sleep changes, and anticipation. Of course, it also brings great joy. So many parents, friends, and families relay sadness they feel on the first day of school (particularly Kindergarten). We shed a layer of innocence it seems when our kids advance. However, one good friend recently described his son’s first day of Kindergarten as one of the happiest of his life. He mentioned he could tell me, unlike other days, what his son was wearing, the pace of his son’s stride that morning as they walked to school, and how he remembers clearly the huge sense of pride both he and his son felt when they landed in the classroom. It was by all accounts, “Marvelous and immensely joyful,” he said. It’s his description that is allowing me to keep my chin up.

We flew kites with friends in celebration of the last night of summer tonight. I teared up at bedtime. It isn’t going to be pretty. Not only does F start Kindergarten this week, he also just announced a wiggly tooth. Be still my Mama-heart…

The beginning of the academic calendar marks a perfect time to pen in milestones for the memory books. Utilizing my coping mechanism for the school start this week, I did an impromptu interview with F on Friday. It wasn’t premeditated so it’s not entirely sophisticated and therefore, very reproducible. I’m hoping to make it an annual tradition to help me both mark transitions but also celebrate his incredible journey growing up. Here’s the 20-question interview with his verbatim responses. Please feel free to provide added suggestions for questions and I’ll do a a follow-up interview!

5 Year-Old Interview, 5 Days Prior To Kindergarten Start

  • What is your favorite color? “Yellow”
  • Favorite number? “5″
  • Favorite food?: “Strawberries”
  • Favorite toy?: “This is going to be a tiny bit hard……airplanes.”
  • What are you most happy about this summer? ”I got to spend more time with Mommy and Daddy” (be still my heart, again)
  • Favorite memory from the summer? “Going through the Costco carwash.” (you can’t make this stuff up) Read full post »

Never Say Never: On Trying New Foods

We went out for sushi on Friday at one of those mall-type restaurants that has little pieces of sushi spinning around the perimeter of the kitchen on a conveyer belt. The gimmick is genius for families with young children. The boys were starving and urged that the sushi spot was their choice for our night out. The conveyer belt provides instantaneous food and also fulfills the need for entertainment. As any normal parent knows, that’s a recipe for perfection. More than half of the people in the restaurant (at 5pm) had kids our boys’ age. It was a typical meal until the most wonderful thing happened: my son proved the husband wrong.

Boys 1, Husband 0.

As the food spun around, the boys eyed their favorites: avocado rolls, noodles, and nori. O asked about the orange “bubbles” he kept seeing. F announced that they were fish eggs. O instantly wanted to try them… The husband: Read full post »

If It Were My Child: No Football For Now

This is a position post where I take a stand that represents no one other than myself as a mom and a pediatrician. The reason I clarify this, is that my position is a strong one. No one wants to go up against someone like the NFL, it seems. But let me say this very clearly: It if it were my child, I’d never let them play football. No way. For my boys, the risks are too large, the sentiments too cruel, and the gains simply not worth it. There are plenty of other sports teams out there to grow, exercise, form friendships, and excel. I never want my children to be a part of any institution that houses intent to harm another human being. Although direct harm may not be a tenet in pee wee football, we all know that young sports teams are built to emulate the pros. If the NFL is the inspiration, for now, count my boys out. This isn’t just about the risk of concussion…

On my way into clinic on Saturday morning, I heard the alleged tape of Gregg Williams directing players to seriously harm opposing teammates. In the tape Mr Williams, the previous defensive coordinator for the New Orleans Saints, employed his players to inflict harm on multiple players–for example, attempt to tear the ACL of Michael Crabtree and work to re-concuss another player, Kyle Williams. Let me point out, some data finds the harms of concussions (particularly in adolescents) may be longstanding, and the risk of a second concussion may rarely be deadly.

In the tape you hear Gregg Williams repeatedly say, “Kill the head, the body will die” followed by, “We want his head sideways.” The tape goes on to capture more directives for harming additional players. It’s nauseating and provoking–got my fingers shaking during my drive. And really more than anything else, it was wholeheartedly disappointing. Particularly for me as a pediatrician. When parents now ask me about football, instead of talking about concussions as a significant risk, I’ll also be talking about ethics, sportsmanship, and integrity.

The great thing is that as parents we have lots of choices. Read full post »

Reading A Growth Chart: Mama Doc 101

Parents, pediatricians, and nurses have been using growth charts since the late 1970′s to track growth in their infants and children. The charts were revised back in the year 2000 as the data for the first charts (from a small study in Ohio) that didn’t accurately reflect the cultural and ethnic diversity of our communities.

The hallmark of a well child check is the review of a child’s growth. Growth can be a reflection of a child’s overall health, nutrition, and/or tolerance of possible underlying medical conditions. So understanding what your doctor or nurse practitioner says about your child’s growth should be a priority.

Watch the video to learn more about interpreting growth charts.

If your doc doesn’t have a computer in the room, ask to see the chart (on paper) or on a computer in their office. It will not only inform you, I suspect it will delight you to see what your child has done since the last time they have been seen.

The human body really is a fine-tuned machine and growth is simply astounding if you really stop to think of it.

If you have a challenge understanding how your child is growing or how the growth chart is presented, demand clarification. It’s okay if you don’t understand the presentation of facts on these grids; have confidence to speak up and ask for the doctor or nurse practitioner to explain it.

Revisions to the growth charts in 2000

Understanding growth charts

Carpooling Reduces Booster Seat Use

Survey results published this week found that the majority of parents report carpooling with their 4 to 8 year-old children. About three-quarters (76%) of those carpooling parents reported that their child used a booster seat when riding in the family car. But when carpooling–the seats were used far less often. For example, the survey found 1 out of 5 parents do not always ask other drivers to use a booster seat for their child. And only half of parents always have their child use a booster seat when riding with friends who do not have boosters. So what your friends do really may change what you do.

This makes sense. I guess. It’s clear people get tired of recommendations. Today, for example, when I sent out a link to the Washington State Booster Seat Law, someone replied on Twitter, “Oh come ON!” Read full post »

The Saturday Box

We’re all looking for little tidbits and rituals to insert into our busy lives that actually help in that quest to have life run smoothly. I suspect The Saturday Box is one ritual worth considering.

I’m not saying that my parents did it all right (ahem….no), but circa 1983, I think the Saturday Box exceeded expectations. Our box inspired a sense of greater responsibility and established a democratic process for clean-up in our home. Less fighting, less let-down, less guilt, and less tension. More responsibility, more ownership, and more order. The genius: the box wasn’t just for my brother and me. Plenty of parental-garb ended up in our Saturday Box and the concept alone invoked a sense of equality. Not unexpectedly, we were occasionally feisty; I have a very clear memory of a family meeting being called after my father’s wallet landed in the Saturday Box….

Watch the video about the Saturday Box. What do you think? Have another successful tidbit to share? Will you do this and report back?

How Much Milk? Seattle Mama Doc 101

We don’t need cows to survive but their milk sure does provide us with a convenient source of calcium. The amount of milk our children need varies with age. I outline needs in the video but know this, as your child ages from a preschooler to a school-age child to a teenager, their calcium needs increase. Of course, if your child doesn’t like milk or is allergic to milk products, you have plenty of ways to get them the calcium they need from other foods rich in calcium to fortified juices to calcium supplements and calcium-fortified bars.

Getting The Calcium Our Children Need:

  • Lowfat milk is an easy and affordable source of calcium, but it certainly isn’t the only one. Other calcium rich foods include soybeans (edamame), tofu, broccoli, spinach, and almonds. Click on that link for a comparison of how much calcium each food contains compared to a cup of lowfat milk.
  • Calcium needs increase by age. Here’s a chart that breaks it down by the milligrams of calcium kids need each day. If you’re not into counting milligrams of calcium, think of calcium needs by the glasses of milk need daily: about 2 cups for 2 to 3 year olds, 2 1/2 cups for 4 to 8 year olds, and 3 cups for rapid-growing 9 to 18 year olds.
  • You don’t need whole milk for proper nutrition after age 2. “Whole” only refers to the amount of dairy fats, not the amount of vitamins or protein. US Studies find that almost 1/3 of families still serve their older children whole milk. I recommend switching to lowfat milk once your child turns 2.
  • Fewer than 1 in 10 girls gets the calcium they need between the age of 9 and 13 years. Fewer than 1 in 4 boys in the same age gets what they need. I’m perplexed by the sex difference, but suspect it has to do with calorie restriction (read: dieting), cultural norms, and the vast array of alternative beverages marketed to teens. When I searched for an explanation, I found data on fur seals. If you know the answer, please leave a comment!
  • If you are concerned your child is lactose-intolerant (very rare prior to age 5 years) consider getting milk products that are lactose-free or getting pills from the doctor that help children digest the lactose (milk sugar).
  • If your child isn’t a milk-hound, consider finding ways to keep calcium-rich snacks within reach. For easy snacks consider a handful of almonds or a piece of low-fat string cheese. Leave them out and in arm’s reach after school.
  • And remember, the only two things your toddler to teen needs to drink on planet earth are milk & water. Everything else is an extra.

Can We Prioritize Sleep?

I wonder, can we prioritize sleep? I mean this sincerely. Can we really value it? Sleep is one of the essential parts of being human yet unlike some of the other essential things (think food, exercise, oxygen, or shelter) no one seems to give us credit when we sleep. Come about age 11, kids start to be praised for their achievements more than their skills in self-preservation.

Like most busy moms, I speak from an experienced place–I’m up early today after going to bed late last night. With the dog awakening us with vomiting at 2:30am, I clocked in under 6 hours of sleep when the alarm clock broke the silence this morning. Clearly it is our own responsibility to find ways to prioritize sleep. No one will do it for us. So, how we both model sleep and also advise our children as they grow matters. It is well understood that sleep deprivation isn’t good for us. It’s not good for our performance, our driving, our friendships, our mood, or even our waistlines.

In clinic, I ask teenagers what time they go to bed. I ask them if they sleep with their phones, if they wake up to an alarm, and how easy it is to fall asleep. I ask parents and I ask about the little ones, too. But it’s the teens (and parents) I worry about most. Those little 6-month-old-midnight-screamers, they’ll figure it out. The over-subscribed-stressed-out high-(or-low)-achieving teens? They need a little time on this…A study published this month only confirms my concern. Read full post »