Dr. P's 2008 Top 10 Back-To-School Tips

"BACK TO SCHOOL" - 3 words certain to fill your children's hearts with despair and yours with joy. As an annual rite of passage, it's a good time to take stock: How can you help your kids to make this school year academically productive, socially fulfilling, and safe as can be?

Here, in no particular order, are my top 10 suggestions. Feel free to share your own.

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1. Get organized! Plaster a monthly/yearly school calendar on the refrigerator to highlight upcoming events, deadlines, etc. Figure out and agree on morning routines: when to get up, bathroom rules and time, getting dressed, eating a decent breakfast, etc. in a "no nagging required / no whining allowed" environment.

2. Talk things over. Arrange a "planned discussion" with each of your kids to talk about academic goals for this year. Is there anything she is particularly anxious about? Be sure you include your expectations for performance - just make sure they are appropriate (if perhaps a tad high) and fair, linked to his/her talents and potential. If she's a brainiac, then good grades are reasonable to expect. If an average student, don't set the bar so high she is sure to fail. Remind her that what you really expect is for her to try hard and do her best, no matter what her final grades may be. Discuss expectations for completing homework. Construct positive (hopefully) self-fulfilling prophecies about the year. Reassure her that a lot of kids are anxious at the first day of school, but you know she'll handle this just fine, as she usually does. Remind her about the good things that happened last year.

3. Talk some more. What are his/her social goals? Is he looking to make new friends? How might he best accomplish that? What might be some of the social challenges this year? Ask about what's important for social status in school this year (it changes on a dime). What kind of clothes, shoes, backpacks, hair styles are in? It's important to give this some sort of adult perspective but - make no mistake - social status is very important to all of us and your kids are no exception. So don't belittle their feelings and desire to fit in, rather help them to achieve that within the values and aesthetics and monetary constraints of your family. Allow him/her to pick his/her own school supplies and clothes, but within an agreed-upon budget and your veto power in extreme circumstances (like too-sexy clothing). Click on the above image to read the very funny Onion parody of necessary school supplies.


4. Discuss and rehearse walking to school safety. Have your child walk (with or without adult supervision, depending on his age) to school if possible. It's great low-tech exercise and a wonderful time to socialize with friends in the great outdoors. Find a couple of reliable pals to walk with each day. Review pedestrian safety. Take a rehearsal walk or two, noting potential dangers along the way. Find a direct, safe route with the maximum crossing guard support. Be sure she always crosses at a crosswalk (or at least a corner). Be sure she understands to look for a green light and walk sign. Be sure she knows to stop at the curb, look left and then right and then left again (unless you're British), and listen while crossing all streets. Beware parked cars or other obstacles blocking vision of the street.

5. Go over appropriate response to strangers. Role play: What if a nice stranger came up to you and asked to help him to look for his poor, sad, missing dog? What if he offers you a ride on a rainy day? How about some candy, little girl? Does it matter what he or she looks like? You don't want to make your kids abduction-fearful, just stranger-wise.

6. If your child is taking a bus, the biggest danger is getting on and off. Go for a bus ride together and show him how to wait at the curb 10 giant steps away from the bus for the driver to stop, how to be in clear view of the driver at all times (don't walk behind the bus!), how to be very careful and make sure all oncoming cars have stopped and the driver has signaled it OK to cross. Be sure to pick a safe spot in the neighborhood for boarding and exiting the bus. Go over your expectations for conduct on the bus. Encourage him to feel safe to discuss any bad experiences on the bus (like bullying or teasing).


7. Don't overdo the weight in the backpack! Don't let your child tote more than 10-15% of his/her body weight in the backpack. Encourage him/her to wear both shoulder straps (to evenly distribute the weight) and to keep the straps tight, so the weight rests against the mid and lower back. Buy a lightweight (but of course, very cool-looking) backpack with padded shoulders, padded back and waist strap so that the bottom of the pack sits a few inches above the back of the waist. Teach your child to pack the heaviest items in the center. Encourage him/her to lighten the load in the school locker during the day. In a pinch, rolling backpacks are catching on (but are tough in the snow).

8. Go over potential bullying experiences with your child. Remind him this happens, but is mean and unacceptable and not to be encouraged. Tell him/her if it happens to talk, walk and squawk. TALK: tell the bully you don't like what s/he has done and that it isn't nice or fair, and WALK: Walk away. Bullies like victims who are passive and come back for more, and SQUAWK: Tell the teachers or parents. Bullies prefer kids who keep silent so they can go about their nasty business without consequences. As a parent, get the school involved in teaching about bullying.


9. Mention the unmentionable: toileting in school (if you don't who will?). For a surprising number of kids this is the most anxiety-provoking part of the school day. In great discomfort, they'll hold it all in rather than face what might await them in the bathroom. Remind them you expect them to ask to go in school whenever they need to go, and to tell the teacher or you if there are any problems in the bathroom. Role play what they might do if someone makes fun of them or offers a cigarette (or worse) in the bathroom.


10 . Whoops, can't think of a #10, so I'll resort to my usual:

Enjoy your kids! Enjoy the ride!
Some day soon you'll wonder how it all went by so fast and why you didn't appreciate it more as it was happening.

Related Topics:

• Back to School in a Wired World
• WebMD Video: Tips to Get Your Kids Out of Bed and Off to School

Technorati Tags: back to school, safety, pediatrics, health and wellness

Mixed Martial Arts for Children

Maybe it's just me.

In a favorite cartoon of mine, a school-aged child innocently asks his father: "Dad, when was it you realized you weren't studly any more?"

I am getting longer in the tooth and am decidedly not studly any more (let's leave aside the question: was I ever studly?). As I have gotten older, I've happily groused in this blog against many of the newer developments for today's youth: their music, social web sites, text messaging 24/7, early introduction to sex, drugs and rock and roll, etc.

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So, as I prepare to rant about yet another 21st century social "advancement" for kids, I really do wonder: Maybe it's me. Am I just getting old and out of it and reflexively intolerant of most things new, like my parents before me who were horrified as I wandered around barefoot listening to the Rolling Stones?

So do Dr. P a favor. Look at this and tell me what you think: Outside the Lines: MMA...For Kids

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"Mixed martial arts" (MMA) is one of the fastest growing "sports" in the U.S.

The Ultimate Fighting Championship - hugely popular on cable TV - defines MMA as "an intense and evolving combat sport in which competitors use interdisciplinary forms of fighting that include jiu jitsu, judo, karate, boxing, kickboxing, wrestling and others to their strategic and tactical advantage in a supervised match...with commission approved definitions and rules for striking (blows with the hands, feet, knees or elbows) and grappling (submission, choke holds, throws or take downs)."

The goal is as simple as it is primeval: to make the other guy (or gal) "tap out" because of pain or being successfully choked or temporarily disabled. Rules include: "No head butting or kicking to the downed opponent. No knees to the head of a downed opponent. No downward point of the elbow strikes. No strikes to the spine or the back of the head. No groin or throat strikes." (Well that's reassuring!)

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You can probably guess how I feel about this mayhem in the guise of sport. For the life of me I don't get why viewers plunk down so much money to watch humans brutally hurting one another. But that's me. I suppose if consenting adults want to watch and participate...

But when MMA is being taught to kids as young as 6 years old, that's a different ballgame and we have to ask ourselves: what is it really teaching and is this a good thing for kids?

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Frankly. every aspect of this sorry saga horrifies me, but none more than the sight of young children being encouraged and rewarded for punching, kicking, twisting the limbs, and otherwise physically attacking one another. Of course, the risk of significant injury is worrisome, but more so is what MMA might be teaching participating children:

• You must learn how to hurt and physically prevail in life.


• Guile, intelligence, strategy, mastery of fine motor skills, are not relevant to succeed in this "sport," (or in life); mostly it's just the greater will to beat up the other guy.


• Unlike other martial arts (like karate), the goal is to inflict pain on the other guy, rather than to master a discipline.
  
• By regularly physically hurting others, might not a child become more and more desensitized to doing so?


• It glorifies street fighting violence.

Of all the many things to teach your kids, this is among the top? Teach your kids to be bilingual, to play a musical instrument, to love science, to play a competitive sport, to participate in a cause. But teach them how to beat the stuffing out of another human...???

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You tell me: is this whole MMA thing another small step backward for civilization as we know it, or is Dr. P just too unstudly to get it?

Related Topics:

• WebMD Video: Preventing Sports Injuries in Kids
• New Strength Training Advice for Kids

Technorati Tags: mixed martial arts, MMA, Ultimate Fighting Championship, UFC, children, pediatrics

New Cholesterol Guidelines for Kids

The lure!........................ The bad guy?........................ The problem.

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On 7/7/08, the American Academy of Pediatrics issued new guidelines for monitoring and treating children with high blood cholesterol levels.* The stakes couldn't be higher. At issue is whether we pediatricians and parents can prevent long term cardiovascular disease in our children by detecting high cholesterol levels early on and by promptly intervening to lower those levels.

The problem is (as I will discuss), the scientific returns are not in as yet, so this is an open question about which you should keep current and discuss with your pediatrician. Because it's so important, I've read the guidelines very carefully. As your faithful cyber-pedi (or am I your pedi robo-cop?), I wanted to share my thoughts.

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First, what do the guidelines recommend?

1. Most importantly, a healthy diet and increased physical activity for all children, including low-fat dairy products for all children over two years of age.


2. Low-fat dairy products for children 12 - 24 months who are overweight.


3. Screening (a fasting lipid profile) - starting at age 2 years and then every 3-5 years - for all children and adolescents with a family history of high cholesterol / high fat levels or early cardiovascular disease.


4. Screening for all children whose family history is unknown or who are overweight, have high blood pressure, or diabetes.


5. Weight management should be the primary treatment for overweight kids with high lipid levels.


6. For patients 8 years and older with an LDL concentration greater than 190 mg/dL (or 160 mg/dL with a family history of early heart disease or two additional risk factors present; or 130 mg/dL if diabetes is present), medications should be considered.

(LDL = low density lipoprotein = the bad guy cholesterol that appears to clog up the works, as opposed to HDL = high density lipoprotein = the good guy cholesterol that protects against atherosclerosis).

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What I like about the guidelines:

• The prevention of adult diseases during childhood is one of our great challenges. These guidelines reinforce that vital pediatric mission.


• It makes sense to me to aggressively intervene with children who already show signs of disease (diabetes, metabolic syndrome) or who are at great risk by virtue of genetics.


• The emphasis on a low animal fat, high fiber diet will serve to improve the health of all humans (see my blogs on this favorite subject of mine: Overweight toddler, overweight teen? Dr. P's 8 steps to a healthier family ).


• I like being given the OK to put chubby one year-olds on low fat milk products.

My concerns about the guidelines:

• I wish they had put more emphasis on fitness, i.e., more exercise for our kids (see my blog: Your teen's physical fitness). Even an overweight child can and should be physically fit, just as even a skinny child can be an unrepentant couch potato.


• Since we know that artery clogging atherosclerosis begins in childhood, it makes sense to intervene early. But, in fact, we don't really know whether lowering cholesterol levels in childhood will, in any significant way, prevent long term cardiovascular disease. Since that is the case, our interventions should at least "do no harm".


• The potential short-term and long-term consequences of using cholesterol-lowering agents during childhood simply aren't known. Just because they appear to be safe in old fogies like me doesn't mean that they couldn't have some sort of unanticipated effect on the growing, changing child's body (especially since cholesterol and fatty acids are essential building blocka for many organs, including the brain).


• For that reason - and until long term studies are done and we know more - unless the risks seem especially high, I'm still not going to recommend medications for my healthy pediatric patients with high cholesterol levels.


• I worry about you all needlessly obsessing about a high cholesterol level in your otherwise healthy, happy, active child, especially since we don't really know what it will mean for your child over time.


• I worry (hey, I worry a lot!) about the loss of a carefree childhood. As I wrote in my old blog: What is lost from childhood when the glorious taste of a hot fudge sundae is confounded by the worry that it is causing blood vessel sludge?

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Dr. P's bottom line: Unless your child has one of the risk factors listed above, don't worry about their cholesterol 'number'. Worry instead about their general fitness and nutritional well-being. Feed them a healthy, low animal fat, low junk food, high fiber diet, make sure they get plenty of exercise, and you'll be doing a superb job.

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* "Lipid Screening and Cardiovascular Health in Childhood"
Daniels S, Greer F and the Committee on Nutrition

Related Topics:

• Kids to Get Heart Disease Screening
• Helping Your 'Not-Thin' Kids

Technorati Tags: pediatrics, childrens health, cholesterol, healthy diet, exercise

A Ticket For Poor Kids

Sometimes the best ideas are the simplest.

I just read an inspiring article in my hometown newspaper. It has provided me with renewed hope that, if only we mustered sufficient political will, we could successfully solve one of our most important social challenges: How to improve the academic performance of poor kids?

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I regard childhood poverty as the single greatest public health menace facing our children. Like most public health threats, we have some good (albeit imperfect) solutions.

After working with inner-city children for almost a quarter of a century (ouch!), I've come to believe that the best ticket out of poverty, the ticket that allows economically disadvantaged kids to become productive members of society, the ticket to their personal fulfillment, is educational success (by that I mean at least finishing high school and, better still, going on to higher level education or training).

How can we achieve this noble but daunting goal, especially given the myriad reasons almost half of poor kids never complete high school: their underfunded, overcrowded schools, parents who neither demand nor expect school success, the myriad psychosocial issues they are dealing with, the unsafe neighborhoods, a peer culture that demeans 'brainiacs', the learned hopelessness... Pick your poisons.

One can become depressed by the intractable complexity of academic failure. It's easy to throw up your hands and declare it hopeless: let's just invest in more police, bigger prisons and unemployment benefits!

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The newspaper article was about the "Say Yes to Education" project, the brainchild of a smart, caring, rich guy named George Weiss. It started over 20 years ago when, while giving a talk to a class of 6th graders in a Philadelphia inner-city school, he made the following promise: "I will pay your college tuition if you graduate high school." In the article, a 25 year old man discusses how Weiss made this same pledge to him when he was in 2nd grade and how it changed his life and the lives of the majority of his classmates.

How simple and how brilliant! Of course we need to improve our public schools. But what about enhancing a child's learning by raising her own internal motivation and aspirations? Mr. Weiss' pledge gave the students (and, of course, their parents) - at an early age - the hope and the inspiration and, most importantly, the means to attain their dreams of making it in this hard world.

The success of this simple strategy has been replicated over and over in the last two decades and gives lie to the perceived hopelessness of the situation. For you evidence wonks (I hope there are a few of you out there), below is an outcome graph you can click on (better still, go to their website, from which it is taken) showing that about 75% graduate high school (compared to the average of about 55% of economically disadvantaged kids), and about 1/2 of those continue beyond a high school education.

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Feeling down in these trying times? For an inspirational pick-me-up and for instructive lessons, do yourself a favor and go the Say Yes To Education website and read about this fabulous project which now provides children with not only the promise of college, but health care and educational supports along the way.

I can't help but wonder, why aren't our federal and state departments of education following their lead? I can think of a lot of worse (and few better) ways to spend my tax dollars.

Related Topics:

• Parental Absence Stifles Kids' Learning
• Less Education, Higher Death Rates?

Technorati Tags: children, education, poverty, Say Yes to Education

Preventing allergies: When to introduce solid foods

Dr. P's Pediatric Journal Club

The study
Data on 2,612 German infants was gathered from birth as part of an ongoing study looking at when solid food was first introduced and the development of allergies by two years of age.

What the study found

• Waiting until after 6 months of age to start solid foods did not have a protective effect on the development of eczema ("atopic dermatitis") or other recognized allergies at age 2 years.
• Waiting until 4 months of age to introduce solid foods may or may not have had a protective effect on the development of allergies. The data were not clear.
  

Dr. P comments
My WebMD Message Board is filled with parents who are agonizing about what, when and how to introduce solid foods to their infants. It's also filled with a ton of different opinions - "I fed my baby cereal at 2 months and she is fine!"... "Hold off until she is past 6 months or she will have allergies!" ... "My pediatrician says that 4 months is OK, but only cereal!" The only similarity between the varying opinions is that each side is 100% certain that their way is the right way!

Whenever there is such diversity in parents' and pediatricians' advice, you can bet it's because kids do fine almost no matter what the parents do, and because there isn't much scientific evidence to guide us one way or the other. (Interestingly, these are often the parenting issues about which the various camps feel most passionately.)

As the authors of this study state: "Scientific evidence supporting a delayed solid food introduction for the prevention of atopic diseases [allergies] is scarce, inconsistent, and based on a few studies only." This study helps by demonstrating there to be no benefit in waiting for more than 6 months, and suggesting that it's still up for grabs whether there is really a benefit in waiting 4 months.

Truth be told, this is a common scenario for pediatricians: often there is insufficient scientific evidence to strongly recommend one practice over another. So we essentially fly by the seat of our pants and make our best judgment based on meager evidence and our experience, and wait for definitive research to clarify the issue.

So here's my seat-of-the-pants advice on starting solid foods:

• Hold off the introducing solid foods until 4-6 months. (Remember that cereal does not increase sleeping through the night!)
• Introduce one new food every few days, so if there is a digestive problem or apparent allergic reaction, you will know what may have caused it.
• Always be sure the texture of the food is such that your baby doesn't cough and sputter when it is introduced.
• Introduce the small amount of the new food when your baby is hungry - before, not after, he has had her milk. Then gradually increase the amount.
• Don't let "neophobia" (fear of new foods) discourage you. Even if your infant doesn't take well to some (or all!) solid foods, never try to force feed him. Remember that milk alone can serve the baby's nutritional needs until at least 6 months. Gently and cheerfully reintroduce the hated taste/texture at another time.
• Most importantly: keep meal time fun and pleasant for all. In the long run, that's much more important than whether your bundle of joy eats his broccoli or not. More than anything else, emotional warmth and support at mealtime is what promotes a love of eating in the child and makes family meals a joy.

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Article cited:
"Timing of solid food introduction in relation to atopic dermatitis and atopic sensitization". Zutavern A, et al. Pediatrics, February, 2006, pp.401-411.

Related Topics: New Clue on How Babies Learn Words, Studies Short on Soy Formula Risk

Technorati Tags: parenting, infants, newborns, feedingsolids, foodallergies