Category Archives: parenting

New information about preventing peanut allergies

An extensive study of children and peanut allergies has recently been released, and it encourages pediatricians to re-assess the recommendations that have been in place for some time. The study, called LEAP (Learning Early About Peanut Allergy), looked at children who have a severe or mild risk of developing peanut allergy and those who don’t.

Peanut allergies have been on the rise in recent years. Conventional wisdom has been that infants and toddlers should not be given peanuts or peanut products until they were older. That wisdom is now changing as a result of the LEAP study, conducted by the National Institute of Allergy and Infectious Diseases (NIAID).

The director of NIAID said in a recent press release: “We expect that widespread implementation of these guidelines by health care providers will prevent the development of peanut allergy in many susceptible children and ultimately reduce the prevalence of peanut allergy in the United States.”

So, what are the new guidelines, and what should parents do about introducing peanuts to the diets of their young children?

For babies who are considered to be at NO risk for developing a peanut allergy, parents can begin introducing peanut butter with solid foods at about six months of age. The LEAP study concludes that once peanut butter is introduced and tolerated with no allergic reaction, it should remain in the baby’s diet with some regularity.

There are different guidelines for babies and young children who are determined to be at moderate or severe risk of developing peanut allergy. How do you know whether or not your child is at risk? There are several factors that contribute to that risk, and it’s a conversation you should have with your child’s pediatrician in the office before introducing peanut butter into the diet.

Your concerns are our concerns, and we look forward to answering any questions you may have at your child’s next checkup.

Good eating habits as a way of preventing obesity and eating disorders

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Back-to-school time involves changes in just about everything: schedules, homework, sports, family time—even eating. Being rushed in the mornings makes having a decent, healthy breakfast a challenge. Families have to decide if kids will take lunch or buy the school lunch. Then comes the evening meal with people going in different directions, and often little time to prepare or eat a meal together. It’s no wonder that healthy eating and family time often take a back seat to homework, sports, and other activities.

As we all know by now, obesity among children and teens in our country is a widespread problem, and eating disorders (EDs) are also more common than before.

An article published last week on the website of the American Academy of Pediatrics (AAP) discusses how the same attitudes and habits can lead to both obesity and EDs. According to one study, dieting can actually be a precursor to obesity and EDs. Dieting “was associated with a twofold increased risk of becoming overweight and a 1.5-fold increased risk of binge eating… Another study found that normal weight girls who dieted in ninth grade were three times more likely to be overweight in 12th grade compared with non-dieters.”

In addition to dieting as a cause, “weight talk”—no matter how well-intentioned—and “weight teasing” can lead to EDs and obesity. “Weight talk, or comments made by family members about their own weight or to the child to encourage weight loss, has been linked to both overweight and EDs. Teasing children about their weight also has been associated with the development of overweight, binge eating and extreme weight-control behaviors in girls and overweight status in boys. Body dissatisfaction is a known risk factor for both obesity and EDs.”

So, how does a parent help a child be satisfied with her or his body? How do you encourage your teen toward a healthy relationship with food? “Adolescents who are more satisfied with their bodies report parental and peer attitudes that encourage healthful eating and exercise to be fit, rather than dieting.”

The article contains recommendations for pediatricians, and that guidance also applies to parents:

“Discourage dieting, skipping of meals or use of diet pills to lose weight. The focus should be on a healthy lifestyle rather than on weight.
Encourage more frequent family meals, which provide an opportunity to model healthy food choices and provide time for teenagers and parents to interact.
Promote a positive body image among adolescents. Body dissatisfaction should not be used as a reason to lose weight.
Encourage families not to talk about weight but rather to talk about healthy eating and being active to stay healthy.
Carefully monitor weight loss in an adolescent who is obese or overweight to ensure the teen does not develop the medical complications of semi-starvation.”

Don’t forget family meals. Though your children and teens may roll their eyes, the time spent together around the table is a time to connect over healthy food and discussions about topics great and small. Turn off the television and cell phones (including yours!) and enjoy each other’s company. It will make all of you healthier.

Drugs and young brains

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According to the American Academy of Pediatrics (AAP), one in four young people (ages 12-17) who uses illicit drugs will also develop a dependency. This is a much higher rate than that for adults.

Why? No one is certain, but there are some known factors.

Heredity is one of those factors. Is there an addict or alcoholic (recovering or otherwise) in your family’s history? If so, be aware that this one factor can greatly increase your child’s chances of developing an addiction to drugs or alcohol. You should talk to your teen about this with the hoped-for effect that she will choose to be more careful.

Here are some other factors listed in an AAP web article:

“Untreated psychological conditions such as depression, anxiety, conduct disorder, oppositional defiant disorder and personality disorder. For these youngsters, as well as for those with untreated attention deficit hyperactivity disorder (ADHD) and other learning problems that interfere with academic and social success, taking illicit drugs may be their way of self-medicating.
Temperament: thrill-seeking behavior, inability to delay gratification and so forth.
An eating disorder.
Associating with known drug users.
Lack of parental supervision and setting of consistent limits.
Living in a family where substance abuse is accepted.
Living in a home scarred by recurrent conflicts, verbal abuse and physical abuse.”

Start the conversation about drugs and alcohol early on, in age-appropriate ways. And don’t assume that just because you’ve had this talk once, that’s good enough. Young people are confronted with opportunities on a regular basis, so make sure that you leave the door open to talking with you about it.

Not sure how to begin? Here’s another great AAP article entitled “Talking to Teens about Drugs and Alcohol.” It gives great advice about a conversation that is essential to your child’s health.

Educate yourself about drugs and alcohol. Have open conversation. Don’t abuse substances. Help your teen stay healthy and free from addiction.

Talking to children after a tragedy

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The recent shooting in Orlando leaves every parent—and anyone who cares about children and teens—in the position of wondering what to say and how to say it. You are reeling from the news, and you want to protect the children you love from being hurt by it.

There is no perfect way to handle tragedy with youngsters, but here are a few basic guidelines. All of the quoted information below comes from an article you may want to read in its entirety, from the American Academy of Pediatrics (AAP).

“No matter what age or developmental stage the child is, parents can start by asking a child what they’ve already heard. Most children will have heard something, no matter how old they are. After you ask them what they’ve heard, ask what questions they have.”
“In general, it is best to share basic information with children, not graphic details, or unnecessary details about tragic circumstances. Children and adults alike want to be able to understand enough so they know what’s going on. Graphic information and images should be avoided.”
“Keep young children away from repetitive graphic images and sounds that may appear on television, radio, social media, computers, etc.”
“With older children, if you do want them to watch the news, record it ahead of time. That allows you to preview it and evaluate its contents before you sit down with them to watch it. Then, as you watch it with them, you can stop, pause, and have a discussion when you need to.”
“Today, most older children will have access to the news and graphic images through social media and other applications right from their cell phone. You need to be aware of what’s out there and take steps in advance to talk to children about what they might hear or see.”
“The reality is that even children as young as 4 years old will hear about major crisis events. It’s best that they hear about it from a parent or caregiver, as opposed to another child or in the media…

The underlying message for a parent to convey is, ‘It’s okay if these things bother you. We are here to support each other.’”

What if you have an older child or teen? “After asking your child what they have heard and if they have questions about what occurred during a school shooting, community bombing, natural disaster, or even a disaster in an international country, a parent can say something such as: ‘Yes. In [Orlando, Florida]’ (and here you might need to give some context, depending on whether it’s nearby or far away, for example, ‘That’s a city/state that’s pretty far from/close to here’), there was disaster and many people were hurt. The police and the government are doing their jobs so they can try to make sure that it doesn’t happen again.’”

If your child seems to be overwhelmed with anxiety after a tragedy, and that feeling doesn’t get better with time, talk to your pediatrician. You may also request our office to refer you to a counselor who specializes in working with children or teens. Signs that they are having trouble coping include problems with sleeping or eating (too much or too little); physical symptoms such as tiredness, headaches, digestive issues; or behavioral changes.

It is only natural to be upset when a tragedy occurs. Every adult feels that way, and so do children and youth. If you haven’t had a conversation with them about it, today is a good time for that discussion.

Sports physicals – it’s time

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Your kids are on the move – literally, and all the time! If they are involved in a fall sport at school, then it’s time for their sports physical. Don’t forget that there is tremendous benefit to getting these physicals at your child’s pediatric office, rather than at a clinic or a school-sponsored physical day. The pediatrician has all your records including vaccinations, allergies, and your individualized and family medical history. He or she can discuss important sports information with you, including nutrition. And, of course, follow-up is always readily available, whether one week or six months from now. We are delighted to be working, with you as our partner, to make a medical home for your family here with us. If your child has a physical at a clinic or the school, that physical is not a part of our records, and we end up with an incomplete picture of his or her development and needs. Read our previous blog post for more reasons on why it’s wise to bring your child to the pediatrician when it’s time for a physical.

Breast development in boys?

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As odd as it may sound, about three quarters of boys will develop some breast tissue early in their puberty. This is a normal physical reaction to the increase of hormones, including estrogen, in the male body as it matures.

Gynecomastia, as it’s called, is a source of concern for many boys because they are unprepared for it and think something may be wrong with their bodies. And, of course, it comes at a time in their lives when they may already feel insecure about their physical and sexual development, when they may already be uncomfortable in the locker room at school

Gynecomastia can start as tenderness or soreness around the nipple and can manifest in one or both breasts. Most of the time, the tissue will only grow a half inch or so, and often will be just around the nipple. It can take a couple of years to go away, but normally it will go away.

You should also know that certain medications, both prescription meds and illegal drugs, can cause gynecomastia. In particular, anabolic steroids, marijuana or heroin can lead to gynecomastia, as can insulin and other prescription drugs.

The information for this blog was gleaned from an article on the website for the American Academy of Pediatrics, an article which contains much more information about male puberty and what changes a boy may expect in his body.

If your son has gynecomastia, make sure he knows the condition is common and will resolve itself with time. Show him this article. Encourage him to talk to his physician who can assure him that nothing is wrong with his body or his development.

Patient-centered Medical Home, Part 2: Your Part

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Remember that you will get the most from your PCMH, Georgetown Pediatrics, if you participate with the team.

What your PCMH team should do:

Learn about your child.
- Get to know your family, your child, your life situation, and preferences. Remember these details about you every time you seek care for your child and suggest treatments that work for YOUR CHILD.
- Treat you and your child as a full team member in your child’s care.
Communicate with you and your child.
- Give you time to ask questions and answer them in a way you understand.
- Make sure you know and understand all of your options for your child’s care.
- Help you decide what care is best for your child. Sometimes more care is not better care.
- Ask your feedback about your child’s experience getting care.
Support you in caring for your child.
- Make sure you leave the office with a clear idea of how to care for your child.
- Help you set goals for your child’s care and help your child meet those goals one step at a time.
- Give you information about classes, support groups, or other types of services to help you learn more about your child’s condition and keep them healthy.

What you can do.

Learn about caring for your child.
- Know that you are a full team member in your child’s care.
- Learn about your child’s condition and what you can do to help them stay as healthy as possible.
- As best you can, follow the plan that you, your child, and your PCMH team have agreed is important for your child’s health. If you have questions, ask!
Communicate with your child’s PCMH care team.
- Always bring a list of questions to each of your child’s appointments. Also, bring a list of any medicines, vitamins, or remedies your child uses.
- Always tell your child’s PCMH team when you don’t understand something they said. Ask them to explain it in a different way.
- Always tell your child’s PCMH team if your child gets care from other health care professionals, so they can help coordinate the best care possible.
- Always talk openly with your child’s PCMH team about you and your child’s experience and getting care from the medical home so they can make care better.

Together, you and we will make Georgetown Pediatrics the medical practice that works best for your family.

Marijuana, the safe drug? Think again.

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Now that laws in some states (though not in Kentucky) are easing in regard to marijuana possession and usage, some teens and adults believe it must be a harmless drug.

Not so, especially for teens.

Marijuana, according to an article by the American Academy of Pediatrics (AAP), affects many aspects of a young person’s mental, physical and emotional health, and it’s certainly addictive.

For someone who smokes or ingests marijuana regularly, clear thinking and good judgment are often affected. This can cause school work (and grades) to falter, and can lead to bad decision-making. The AAP states that marijuana users are more likely to engage in “unwanted or unprotected sex” because their judgment is impaired. Also, “Those who drive or take other risks after smoking marijuana are much more likely to be injured or killed.”

According to the same article, because teens are still growing and developing, marijuana usage “can lead to a wide range of serious health problems, including heart and lung damage, cancer, mental health problems, and addiction. Depression, anxiety, and schizophrenia occur more often in marijuana users.”

How to prevent addiction to marijuana and other drugs in your teen?

Educate. Make sure you know about drug usage and its signs, and educate your teenager. When you see someone else acting irresponsibly, or hear about a situation of driving under the influence, initiate a calm discussion.
Monitor. Don’t assume your child will never try drugs. Marijuana, say teens, isn’t that hard to come by. Watch for signs. Pay attention to the people your kids hang out with.
Be an example. Don’t abuse drugs or alcohol. Make sure illegal drugs have no place in your home.
Get help. Make sure your teen sees a counselor if needed—not just if she is using drugs, but for any emotional or educational issues. This is a serious concern and outside help is sometimes needed.
Be aware. If you think your child could be using drugs, you may contact our office for a drug screen.

Your teen needs you to keep an eye on his total well-being, and that includes making sure he stays away from addictive substances.

Dangers of e-cigarettes for children and teens

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The American Academy of Pediatrics (AAP) has recently expressed their concerns about electronic cigarettes at a congressional hearing and on their website. In an article entitled “E-cigarettes: Dangerous, Available & Addicting,” the AAP warns parents about the problems with e-cigs, and those problems are many.

Many adults use e-cigs to try to end their smoking habit. E-cigs deliver nicotine through a battery operated device that resembles a cigarette, but without the tobacco or smoke. The e-cigs use water vapor to deliver the nicotine.

You may think that e-cigs are safer than tobacco cigarettes, but you should know that, according to the AAP, an e-cig “can have as much nicotine as a whole pack of cigarettes. In addition, the Food and Drug Administration (FDA) has found cancer-causing chemicals in electronic cigarettes.”

This presents a host of dangers.

Teens, apparently believing that e-cigs are safe, have doubled their use of these devices, bringing the usage to about 1 in 10 high school students. They may be avoiding tobacco, but nicotine is highly addictive.
The AAP is concerned about some e-cig flavors (e.g., vanilla, chocolate, peach schnapps and gummy bears). In the congressional hearing Dr. Suzanne Tanski answered “yes” when asked if she believed these flavors would be appealing to children.
Nicotine is a poison. The cartridges that contain nicotine are not childproof, and, says the AAP article, “Most cartridges have 20 milligrams of nicotine, and a dose of as little as 10 milligrams of nicotine can be fatal for a child. In addition, children can easily become hooked on the nicotine.”
E-cigs are widely available. Even though Kentucky law prohibits their sale to minors under the age of 18, they can be purchased online.

Keep your children away from electronic cigarettes and keep them safe from nicotine addiction or poisoning. If you are trying to quit smoking, nicotine patches or gum are safer alternatives.

Back in School, Part 4: Friends

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While you are worrying about your child’s academic year, he is probably more concerned about friends. Honestly, he has a point. While academic skills are an important part to future success and happiness, so are the social skills that help us make and keep friends.

Children at a very young age are usually too self-centered to have friends. This isn’t their fault; it is just a normal developmental stage. If you watch a couple of toddlers on a play date, they will usually engage in what is called “parallel play,” meaning they play side-by-side, but not really together. Even so, you can start to teach them to share, not to grab toys away, etc.

By school age, most children want friends, whether it is just one or many. Good social skills are learned from parents, teachers and peers. Here are some behaviors you can teach your kids that will serve them in school and throughout their lives.

Kindness. Use kind words and tones around the house. Don’t allow your children to be unkind to their siblings, to pets or to adults. Everyone responds positively to kindness, and no one likes a bully.
Politeness. (See our post on manners.)
Assertiveness. You don’t want your child to be aggressive toward others, but you want her to be able to assert her opinions and express her feelings without being overbearing. This takes practice, and it can be something you encourage through conversation, questions, and even role playing. For example, “What will you say if your friend wants to play kickball and you’d rather swing?” They can learn from you the give-and-take of good relationships.
Meeting and greeting. Teach your youngster to introduce himself and to ask questions about another person. They can learn to shake hands, make eye contact, smile.
Listening. Hearing what another person has to say is as important as expressing your opinion.

Here’s a really nice FREE online resource entitled 101 Ways to Teach Social Skills to Children. While the games and activities are designed for groups, many of them can be adapted for use within the family—a fun way to learn appropriate ways of behaving in different settings.

Every school in Scott County has a counselor who can observe behavioral issues both in and out of the classroom, and who can meet with your child and/or other students if needed.

A final word: pay attention to the friendships your child/teen is forming. Get to know his friends and their parents. Make sure their behavior isn’t out of line with what you expect from your own kids.

The friendships we form in childhood and adolescence may or may not last a lifetime. But they teach us skills and behaviors that are timeless.