Category Archives: preteens

Manners? Yes, please.

Summertime is easy—so they say. It can also be an easier time to remind children and teens about good manners. Hopefully, you will have more times of relaxed conversation when you aren’t trying to juggle homework, school and extracurricular schedules all at once.

Manners are important because they remind us of the value of every human being. Saying please and thank you is respectful, whether those words are spoken to someone in the family, a teacher or coach, or a complete stranger. Being helpful ingrains kindness in the helper and encourages it in the recipient and observer.

What are age appropriate manners?

Ages 2—5. Teach children to say please and thank you at the right times. Children at this age usually love to help people, so encourage that tendency. At the playground, they can help a younger child, with supervision. At home, they can learn to pass the potatoes. When meeting someone, they can shake hands and learn to answer questions that are asked.
Ages 5—7. As the child develops physically and emotionally, so should their moral growth be progressing. Teach good phone manners by practicing in a game. Have a “manners night” once a week at the supper table, where everyone has to speak politely and initiate good conversation. Give a small reward at the end of the meal for the person who showed the best manners.
Older children. Learning to smile and maintain eye contact during a conversation is important as children grow. They can learn to ask people about themselves, and to distinguish between appropriate and inappropriate questions. Your suppertime conversations can engage their imaginations and teach them how to talk to other people.
Teens. When our children mature into teens, they often become less receptive to their parents’ helpful instructions on manners, but that doesn’t mean you can let them off the hook. By now they should know your standards, and you should be able to witness them using their manners at home and elsewhere. Teens who are mannerly, you may tell them, will likely advance at school and work because others respond positively to our good behavior.

Perhaps the main thing to remember about teaching manners to your children is this: be an example. Use please and thank you when you remind them about their chores. Treat your spouse and other adults and youngsters with respect.

If you are often cross with them, they will reflect that attitude back to you and to others. But if you treat them and others kindly, they will learn to mimic that behavior, both consciously and unconsciously.

Expect good manners from your children and that is likely what you will get.

Appendicitis

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Do you ever wonder whether abdominal pain warrants a call to the doctor, or even a visit to the emergency room? How can you tell?

One worry with children and teens is appendicitis. The appendix is a small, tubular-shaped organ in the lower right abdomen, that has no known function. Sometimes it can become inflamed and needs to be surgically removed. If left alone, an inflamed appendix can rupture and cause very serious illness.

Appendicitis can occur at any age, and is often difficult to diagnose.

The American Academy of Pediatrics has a great article here about appendicitis. The main symptom is pain, which begins as a “vague stomachache near the navel,” and then is described as a combination of a sense of fullness and pressure on the lower right side. Here is the complete list of symptoms they give, some of which are similar to stomach viruses, and some of which are different:

“Persistent abdominal pain that migrates from the midsection to the right lower abdomen
Nausea and vomiting
Constipation
Gas pain
Diarrhea
Low fever, beginning after other symptoms
Tenderness in the right lower abdomen
Abdominal swelling
Elevated white blood cell count
Appetite loss.”

Call your doctor immediately if your teen or child experiences these symptoms. Have him lie quietly and “don’t offer water, food, laxatives, aspirin or a heating pad.” Any movement can increase her pain. If appendicitis is suspected, a blood test (to determine white blood cell count) will likely be taken, possibly with other diagnostic tests.

I’m thirsty!

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School is almost out and warmer weather is on its way. Hydration is always important, but never more so than when you’re active in warm temperatures. What are the best things to give your kids to drink, and are there drinks they should avoid?

First, drinks to avoid completely:

Energy drinks. Make sure you know the difference between sports drinks and energy drinks. Energy drinks contain stimulants like caffeine and are not appropriate for children and teens. According to the American Academy of Pediatrics: “Caffeine… has been linked to a number of harmful health effects in children, including effects on the developing neurologic and cardiovascular systems.” Caffeine is a drug, and is addictive.
Caffeinated soft drinks. (See bullet point above about the ill effects of caffeine on children and teens.)

Drinks that are okay for occasional use:

Sports drinks. These replace electrolytes and calories lost from prolonged exercise.
Non-caffeinated soft drinks. They are okay on special occasions, but only for older children. Sodas are acidic and therefore are harmful for teeth. Add sugar to that equation and you could be creating some real dental health problems.
Sugary drinks, carbonated or not. These have been linked to childhood obesity in children as young as 4. As with soft drinks, all sugary drinks can cause tooth decay.
Fruit juices. Better options than carbonated drinks, and often a good source of vitamins, they are still calorie rich and shouldn’t be overused.

Drinks that are best:

Water. Always the best way to hydrate, water can be a great part of the healthy child’s diet throughout the day, even when they’re not thirsty. Your kid doesn’t like water? Check out the flavor packets and squirts that add flavors to water.
Low fat milk. If your child or teen can tolerate milk, it is an indispensable source of calcium. If she is unable to drink milk, talk to the pediatrician about alternate sources of calcium.

Finally, a note about very young children.

Nothing but breast milk or formula should go in a baby’s bottle. Even fruit juice is too sugary and can lead to tooth decay. Read here about beverages for the very young.
Children can start learning to use a cup at about 6 months. Still, limit juice to 4-6 ounces per day until the age of 2.
Wean completely from bottles at about 12-15 months of age.

What we drink becomes habit, and starting good drinking habits in childhood is an excellent way to build healthy bodies and teeth for a lifetime.

ADHD—diagnosis, treatment and your concerns

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You hear so much about ADHD these days. It’s in the news. You likely know children, teens or adults who’ve been diagnosed with it. Debates continue about under- and over-diagnosing, and about medicating.

First, just what is ADHD?

ADHD is Attention-Deficit Hyperactivity Disorder. Of course, nearly all children will sometimes be hyperactive and lack focus. How do you know when it’s a problem worth taking to your pediatrician?

The American Academy of Pediatrics has a great article covering the basics of ADHD in which they say, “Children with attention-deficit/hyperactivity disorder (ADHD) have behavior problems that are so frequent and severe that they interfere with their ability to live normal lives.” We might add that family life is also greatly affected by a child with ADHD. This same article deals with concerns about medications and why more children are now being diagnosed with ADHD than, say, 10 or 20 years ago.

Another fascinating article about the trend is here, from MacClean’s.

The bottom line is this: yes, it’s a real problem. And yes, it may also be over-diagnosed.

Families of children and teens who have ADHD find that the right medication in the right amount can profoundly help. Specific testing is needed up front, then some time is often required to pinpoint and adjust the proper medication. In addition, coping mechanisms for studying, chores and social skills can assist parents in dealing with ADHD.

At Georgetown Pediatrics, we are conscientious in making the right diagnosis for your child. Four of our physicians (Dr. Hambrick, Dr. Hoddy, Dr. Sweigart and Dr. Forster) are specially trained to diagnose and design a treatment plan specific to your child. With compassion we can help you find your way to a less stressful future with your family.

If you have concerns that your child may have ADHD, contact our office for an appointment.

Screen time for computers and games

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A couple of weeks ago we dealt with content of video games here. If you missed it, check out that important information about monitoring what your kids are playing. It’s also important to supervise all computer screen time.

Make sure all the computers to which your youngster has access are in open places in the house. Search the browser history at regular intervals, and make sure you have his passwords for all social media accounts so you can check that activity. Let him know ahead of time that this is one of the rules for the privilege of using the computer and smart phone. Take a look at texts and other accounts on her phone, and remind her of safety rules:

Never give out personal information online or over the phone.
Never assume that someone you “meet” online is giving you accurate information, and never arrange to meet such a person face to face.
If you get concerned about someone contacting you, tell your parent without fear of judgment.
Never use your phone or computer for pornography (especially child pornography, which is illegal), sexting (a form of pornography), sending any inappropriate information, or for hurting or bullying someone else. If you receive such content inform a parent or teacher immediately.

In addition to content, you should be aware of time. Screen time of any kind (television, movies, computer, video games) means fewer hours are available for physical activity, face-to-face interaction, reading and homework. Screen time isn’t necessarily bad in itself, but you should monitor the amount of time.

The American Academy of Pediatrics gives great advice about video games in this online article, including the recommendation to limit video game time to one hour per day. The same goes for other types of screen time. If your teen or child is spending much more time than that in front of a screen (unless, of course, it’s for school), engage him in conversation about what other activities might take the place of some gaming hours. Allow her to choose from a list of fun ways to spend her time.

Reading. If your children don’t like to read, read to or with them. Pick an age-appropriate book and take turns reading pages or chapters. Bedtime is great for this.
Physical activity. One of the problems of screen time is its sedentary nature. Inactivity leads to weight gain and all sorts of accompanying health issues. Get your youngster involved in a team or individual sport. Go walking or swimming. Shoot hoops in the driveway or play catch in the backyard.
Board games. Remember Candy Land? Connect Four? Pictionary? Games are widely available and great fun. They afford great opportunities for interaction, and for learning life skills like winning, losing, and cooperation.
Face time. Not the phone app, the real face time. Find something you and your teen can share and enjoy: cooking, eating, hiking, stamp collecting, whatever works for you. Time invested is time well-spent. You will reap the rewards in getting to know your child better, and they will reap the rewards in knowing you.
Channel that interest in computers to online learning games, or learning video games. Check out learning games on Amazon, or try one of the websites like Adapted Mind, where you can get a 30 day free trial of games for grades 1-6 (if you continue on with membership there’s a monthly fee).

Bottom line: be in charge of what your children do, even if they aren’t always in favor of your monitoring and limits. It’s your job, and you are aiding in their full development.

Video games—pay attention to what your kids are playing

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As technology increases at home and school, video games have increased in number. Each year they become more realistic-looking and exciting. But they are also often violent, and may contain language and themes inappropriate for your youngster.

Playing video games has benefits, to be certain. They help young people learn eye-hand coordination and computer skills, things they will need to keep up in the modern world.

But there are down sides, too. Big ones. Questions and concerns about content top the list, but you should also be aware that many online games require the sharing of personal information and location.

First, content. The debate continues regarding whether or not violent video games encourage violent behavior. Opinions abound, but the bottom line is that you should monitor and decide what your child or teen can or cannot play. In addition to violence, language and themes may often be too adult.

Understand ratings. The ESRB (Entertainment Software Rating Board) rates virtually all video games in terms of content, age-appropriateness, and interactive elements (including whether or not location and other information is shared). All three of these areas are important.
Content and age-appropriateness. The ESRB website has a great video and also written language to help you understand ratings and how they define words such as “animated blood” and “adult humor.” The basic content and age ratings are:
- Early Childhood;
- Everyone;
- Teen (13 and up);
- Mature (17 and up);
- Adults only.
- Pay attention! Games rated “Mature” have truly adult themes (sex, violence, language) and are simply NOT appropriate for younger ages. Even those with a rating of “Teen” may surprise you with their level of violence and tasteless language.
- PREVIEW. Learn about games before you buy. This website at Common Sense Media is a great source of information. If your youngster is asking for a particular game, look for the title here to see some screen shots and other details.
- Interactive elements. If you are concerned about private information being shared, or worry your child or teen might be connecting (accidentally or purposefully) with people you don’t know, READ THIS.

One important note about violence. Whether or not your teen or child plays violent video games, you should pay attention if he exhibits violent behavior. If she is violent with you or other family members, with schoolmates or with animals, talk to your pediatrician about finding a counselor.

Bottom line: know what your child is doing, watching, playing. Video games are fun, but you need to be aware of content and privacy.

Gun safety

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According to the American Academy of Pediatrics (AAP), 44 million homes in the U.S. have at least one gun. In this season when your youngster may be visiting in homes of friends and relatives, or even spying for hidden stashes of gifts, it’s a good time to review gun safety.

If you own a gun, it needs to be unobtainable for a young person, not just out of sight. Children, even the very young, have an incredible knack for finding hidden things. A three-year-old, for example, found a gun hidden between his parents’ mattress and box springs. Guns should be unloaded and locked away in a cabinet for that purpose (preferably one that doesn’t have a glass or other see-through door). Ammunition should be kept in a separate, also locked, location.
Talk. Tell your children about the dangers of guns. Be clear about rules and firm about what privileges will be taken away if they break those rules.
Ask. If your child or teen is going to someone else’s home, ask whether or not that home has guns and, if so, how they are stored.
Don’t assume. Children are inquisitive; teens want to fit in. If they see a gun, no matter how well they know your rules, they are likely to want to touch it and play with it.
Also, don’t assume that your child would never choose to be violent toward herself or that he would never choose to harm others. Young people, no matter how good the parenting and how delightful the child, often make bad judgments, especially in the heat of a moment. In addition, mental illnesses such as depression can surface at nearly any age.
Some more statistics from the AAP: A gun kept in the home triples the risk of homicide. The risk of suicide is 5 times more likely if a gun is kept in the home.

For more information from the AAP, check out this link or this video.

Remember, safety is a huge part of staying healthy.

artwork by Corinne

Our own dietician on staff!

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Did you know that Georgetown Pediatrics has our very own dietician? Amy Crist has been with us for about 9 months and is available by appointment through our office.

Working part-time for us, Amy is a registered dietician (RD) with a master’s degree, has also worked at Georgetown Community hospital, and makes her home right here in Georgetown.

Amy loves working with infants, children, adolescents and their parents in developing healthy eating habits, including those who have dietary restrictions. She is a frequent speaker at local elementary schools to teach children about healthy eating and nutrition. She’s even led a support group on breast feeding. She is happy to have an appointment with you and your child or teen to discuss:

breast feeding,
dietary restrictions and planning as a result of disease or condition (diabetes, drug therapies, etc.),
concerns about weight or eating disorders,
helping the whole family develop healthy eating habits,
diet and sports,
picky eaters,
and anything else you want to talk over with a dietician.

Call our office and set up an appointment soon!

Amy Crist, our dietician

Keeping Healthy

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Cold and flu season is here. It arrives with colder weather as people spend more time indoors, in close quarters, where germs are more easily passed from one person to another.

Here are just a few reminders of how to help keep your family healthy.

Wash hands. Good old soap and water are still the best protection against contagious diseases that get passed through touching surfaces, shaking hands, etc. Get your family in the practice of washing their hands often. When soap and water are not handy, use hand sanitizer.
Get plenty of sleep. Being well-rested keeps your immune system stronger.
Don’t share. Okay, you teach your kids to share, but some things ought to be for just one person. Water and soda bottles, lip balm, musical instruments all fall into this category. If you have a youngster in child care, make sure the provider sanitizes toys and tables daily.
Cover. Cough or sneeze into a tissue. If there’s no tissue, use the crook of your elbow instead of your hand. Germs on the hand are more easily transferred to other people or surfaces.

Already have a cold? Continue to do all the above, and make sure you stay hydrated. Drinking plenty of fluids keeps mucous thin and your throat moist. Avoid caffeinated beverages.

It’s going to be a long winter, and your family will likely get colds at some point. Use the common sense advice above, and you may have fewer of them.

artwork by Kennedy

HPV vaccine: the who, what, when, and why

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You’ve heard of HPV (Human Papillomavirus), but you may not be sure what it is or what (if anything) you should do about preventing it in your children and teens.

[Most of the information that follows is adapted from the websites of the Centers for Disease Control and Prevention (see here at CDC).]

THE WHAT: HPV is the most common sexually transmitted infection (STI), and there are more than 40 types of HPV. It’s unrelated to HIV, herpes, or any other STI. HPV can cause genital warts, cervical and other types of cancer.

There are two types of vaccine. Cervarix is for females only, and protects against cervical cancers. The other, Gardasil, is for both males and females, and protects against genital warts as well as cancers of the cervix, anus, and vulva. As of 2012, over 46 million doses had been distributed in the US (most of them Gardasil). The vaccine is considered to be very safe and highly effective.

THE WHO AND THE WHEN: Both males and females can contract HPV, from genital contact or from oral or genital sex. It’s recommended that preteens (ages 11-12) of both sexes receive the series of three doses so that they can develop an immune response before they become sexually active. Gardasil is considered effective in teenagers and young adults through the age of 26.

THE WHY: Since a person can contract HPV even if he/she only has one sex partner, and since someone can have HPV for years without symptoms and therefore not even know that she or he has the virus, parents should consider whether this vaccine is right for their preteen or teen. The very good news is this: studies indicate that the vaccine is highly effective: the HPV rate of transmission in adolescents is declining faster than expected.

Ask your pediatrician about this. That’s why we’re here.

artwork by Camille