Technology and Children, Good or Bad?

Dr. Claire McCarthy from  Children’s Hospital of Boston published a very interesting blog post regarding the need for “parents” and “pediatricians” to reconsider the way we approach modern technology with our children.

Coincidentally, Dr. Betancourt and I were discussing this issue recently. We were discussing how much time we should allow our 12 year-old daughter to spend texting with her friends.

 

I suggested we should not be too concerned with how much time she spends texting (as long as it doesn’t interfere with her responsibilities) because it is now the way children communicate. It is their thing now, just like it may have been previous generations thing to spend hours and hours in front of a TV screen or another generation’s thing to spend hours and hours talking on the telephone. As a pediatrician, Dr. Betancourt wasn’t convinced with my point of view.

Dr. McCarthy acknowledges that pediatricians frown upon “screen” time. She says:

We stress the 2-hour limit to help prevent obesity. We warn about Facebook depression, exposure to violence and sex, cyberbullying and online predators. We talk about how texting can keep kids up at night and how video games can contribute to ADHD.

And although she continues to support this message, Dr. McCarthy says that when we just focus on the negative, parents and pediatricians may miss two important points which are: technology is not ALL bad and, as she puts it, for better or worse, digital media is here to stay.

If we are just negative, we may miss the opportunity to inform the discussion. Pediatricians may miss the opportunity to guide children and families in the best uses of technology. Someone else will step in and do it, someone who doesn’t understand child health and development the way pediatricians do. And kids aren’t going to want to talk to their parents about what they are doing online if they think that their parents’ only response will be disapproval.

 I like Dr. McCarthy’s call. She is challenging pediatricians (and parents as well), “to meet kids where they are” and start becoming more connected their world.

It’s hard to inform a discussion about something you don’t know about. So pediatricians and parents should explore the Web and see what’s out there. Do health searches; see what pops up. Find sites and applications that you like and can recommend. Talk to kids about how they use technology—learn from them. Check out Facebook and Twitter and YouTube. Consider using social media yourself.

To read Dr. Claire McCarthy’s post, you may click here 

As parents, do you think McCarthy has a point? Is there anything you’d disagree with? How are you dealing with “screen time?” Do you tend to have a more conservative view, like Dr. Betancourt or are you more like me? We’d love to hear your thoughts. Do Parents and Pediatricians Need to Reconsider How Children Use Technology?

Vitamins: Which One is Right For My Child?

Written by Sandra Graba, MD

With so many vitamin options available, choosing the right vitamin for your child can be a daunting task.  

Not all vitamins are all the same!  The age and health history of your child are important factors to consider. A premature infant will have different requirements than a healthy 2 year old.

My goal here is to give a sense of direction in the vitamin isle, but it is important to discuss individual needs with your doctor.

Often doctors will prescribe vitamins for your newborn, so that makes it much easier! Other times, they tell you the name of the vitamin to choose in the isle.  The vitamins your pediatrician recommends at this age is a little different depending on whether your breastfeeding your child or not.

Vitamins For Newborns

Vitamin K is very important in the newborn period but thankfully all babies get a vitamin K shot right at birth and the subsequent needs are met by breastmilk and formula. Breast-fed babies need extra vitamin D: 400 IU and iron supplement of ~ 11mg daily starting at 6 months.

Six Month Old

Typically, pediatricians will give D-visol (vitamin D) through 6 months of age, then switch to poly-vi-sol (multivitamin) with iron starting at 6 months, but some pediatricians opt to start the multivitamin from the start.  Either choice is fine.  All formulas are iron and vitamin fortified to contain at least the recommended daily amounts for the first year of life.  

12 Month Old

After the 1st birthday, life is completely different!  Your little baby is turning into a toddler and with it comes a whole new challenge: feeding.  We switch them from their vitamin fortified breastmilk or formula to whole milk and table foods.  

Toddlers

The tricky part is that toddlers are inherently picky!  They manage to get enough calories  through all of the “picking” of their food, but do they get enough vitamins and minerals?

Consider this: One cup of whole milk (about 8 oz) has only ¼ of the recommended daily allowance of vitamin D, ½ to 1/3 of the amount of calcium, and no iron.  This means that your child will need to drink 16- 32 oz (2-4 glasses) of milk to get all the vitamin D and calcium they need – but you would still need to consider their iron needs.  

Also, high volume of milk intake (more than 16 oz a day) can lead to anemia.  Translation: your mom was right that milk is good for you but there is too much of a good thing.

So, what to do? In general, all vitamins and minerals are important, but some are easier to get them to eat than others. We can focus on a few important ones:  vitamin D, calcium, iron, B vitamins, and folate.

• Iron is important in red blood cell formation and neurologic development among other things.  It is plentiful in meat, dark leafy green vegetables, beans, tofu, cereal and bread. 1-3 year olds need about 7mg per day, 4-18 year olds  about 10-12 mg per day except for menstruating adolescent girls who need about 15mg daily.   
• B vitamins are important for production of oxygen carrying cells and can be found in fish, poultry, meat, eggs, dairy, leafy green vegetables, beans/peas, breads and cereals.  B6 and B12 are fairly easy to get in the diet.  1-8 year olds need about 0.5 - 0.6 mg per day and teenagers need about 1.0-1.3 mg/day.  
• Calcium is  very important for growing bones.  Some sources of calcium include cheese, yogurt, orange juice, fortified breads and cereals, spinach, and salmon.  1-3 year olds need ~ 500 mg a day, 4-8 yo need ~ 800 mg a day. and  9-18 year olds need ~ 1,300 mg a day.
• Vitamin D is a tough one! The best source is the sun…but we spend most of our year bundled in sweaters, coats, scarves…you get the idea.  There are a few natural food sources: cod liver oil, salmon, mackerel, tuna, liver, and egg yolk.  My 3 year old definitely won’t eat liver.  Thankfully,  cereals and dairy are fortified.  The current recommendation for all age groups is a minimum of 400 IU daily.

After sorting through the vitamin isle, it seems that either Flintstones’ Complete – it is ½ tablet for 2-3 year olds and a full tablet for older than 4 years or Centrum Kids Complete Multivitamin are the best bet for toddlers and school age kids.  

Even still, they don’t provide 100% of the calcium and vitamin D in 2-3 year olds but they are pretty good for iron, B vitamins, and folate.  

There are so many character and flavor choices available but the nutrition guide for these two vitamin types can at least provide a guide to compare the other vitamins to while your head is spinning in the isle.  Overall, remember that vitamin supplements are just that – supplements to a healthy diet.  Children with any special needs will have different requirements.

A few words on Gummy vitamins…

Though they taste good and are probably easier to get your children to take, the vast majority I have seen fall short in providing the necessary daily nutrients.  Many contain ¼ to ½ the amount of vitamin D and 10% or less of the needed calcium;No gummies contain iron. Many have the minimum amount of B vitamins but less than the recommended folate. Each gummy does, however, contain about 3g of sugar.  If the serving size for your child is 2 gummies, giving them their vitamins is about the same as giving them a ¼ cup of soda!  

Having a Hard Time Getting Kids to Bed? Try These Tips

Written by Marciann Bock, APN

As a mother of four, bedtime can become a stressful part of my daily routine.  

Children have a gift when it comes to bedtime avoidance.

How many times have you heard these night time avoidance tricks: “one more book" "I need a glass of water," "I'm hungry!" "I think something is under my bed.” Just when you are sure they are tucked in, you turn and find them standing behind you or crawling into your bed.

This may or may not concern you, but it is important to understand that irregular sleep patterns can lead to “excessive daytime sleepiness.”  The AAP gives a great overview of this problem and ways to help nip it in the bud!
 

“Excessive daytime sleepiness (EDS) can be caused by insufficient sleep, fragmented sleep, or increased sleep drive. Although some sleepy children appear to have difficulty remaining awake, many sleepy children may exhibit hyperactivity, restlessness, poor concentration, impulsivity, aggressiveness, or irritability.”

Your child's problem may be related to fear.  Many children fear separation from the parents, they may be experiencing bullying from peers, a change in the family dynamics (sibling birth or a relative death) which can cause doubt and  uncertainty.  

Simple exposure to inappropriate media such as a scary movies, television shows or video games can lead to fearful thoughts.  Children's fears are real and need to be addressed.  The AAP has recommended some ways to assist your child in handling these fears:

• Acknowledge the child's fears: Children are still learning the difference between fantasy and reality.  So even though we understand monsters do not live under the bed children may still fear the monster exists.  
• Reassure them you will keep them safe: If a monster is under the bed, spray it with the miracle monster evaporator, check the closets,  or tell them the doors are locked with the special mommy lock that keep the monster's out.
• Empowerment stories: Go to your local library and get books on being scared, make sure it is age appropriate and read it with them.
• A night light: a simple night light helps keep the boogy man away.  When children can see there is nothing in the room they feel a little comfort in closing their eyes.

Fear or no fear children can manipulate any situation, and bedtime is no different.  When you are faced with an manipulative child you need to stay strong, hold your ground and keep a healthy bedtime routine.  Here are some tricks from the AAP on getting your child into bed and keeping them there!

• A bedtime routine should take less than 30 minutes, from brushing there teeth to saying goodnight.
• The child should have the parents undivided attention during this period.
• Activities should have a set length (ie: 2 books or 3 songs)
• When setting the limit you must stick to it (just one more book), when you give in once they will continue to ask for more.
• You must ignore request for more, arguing manipulation and encourages your child to continue to ask.
• Ensure them you will check in on the child within a few minutes and follow through, this is reassuring and gives them a sense of security.  But never allow them to get out of bed during that period.
• Positive reinforcement, stickers or an extra book the next night can give them incentive to stay in their beds through the night.

Try these helpful hints from the AAP and ask around, you may find friends and family with similar problems, more importantly some other helpful advice.

Back to School Illness... What Can I Expect?

Written by Melissa Arca, MD

First of all realize it’s inevitable. Children will get sick. I have yet to meet a child in school who went the whole school year without coming down with something. That being said, there are measures we can take to lessen the chances of our children falling prey to some of these viruses.

First, I will outline 5 of the most common culprits causing illness in the preschool and school age child during Fall and Winter. Then I will give you some practical tips on containing these viral bugs.

Hand Foot Mouth Disease: This is most commonly caused by the coxsackie virus and peaks in the summer and early Fall. This virus affects mostly young children (children under 10). The symptoms consist of a fever, decreased appetite, and sore throat. Usually painful mouth sores develop on the tongue, inside of cheeks and back of throat. This may or may not be accompanied by the non-itchy skin rash on palms and soles of feet.

The Common Cold: Your child may be afflicted with this a few times a year. The most common culprit here is the rhinovirus though there are several different viral strains producing symptoms of the common cold. Hence, several colds can be caught during one season. The symptoms vary but most commonly include: stuffy nose, sore throat, cough, mild fever, and sneezing.

The Flu: Ahh…the dreaded flu. Influenza and it’s various strains cause the dreaded flu symptoms. As opposed to the common cold, the flu gives more pronounced and severe symptoms: high fever (usually over 100.4), sudden onset of symptoms, profound body aches, headache, and general malaise with decreased appetite. With the common cold, respiratory symptoms such as sneezing, congestion and cough are more prominent than in the flu. So far, the only preventive medical defense we have against this is the seasonal flu shot.

Strep Throat: Unlike the above conditions, this one is caused by a bacteria (Group A Strep.) and not a virus. So, this must be treated with antibiotics. So how do you tell the difference from a common sore throat (viral pharyngitis) and strep throat? Here are the key differences: strep throat involves a higher fever (usually above 101 F), red and swollen throat with possible pus formation, absence of cough, and swollen lymph nodes in neck. Strep throat may also be accompanied by abdominal pain, possible vomiting, and a body rash.

Gastroenteritis aka the “stomach flu” is caused by several different types of viruses, most notably rotavirus and adenovirus. The most prominent symptoms are vomiting and diarrhea. Some children may only have the vomiting, some only the diarrhea, and the unlucky ones will have both. This may be accompanied by fever and stomach ache. Having the so-called “stomach flu” does not mean you have the “flu” as in influenza.

I picked the above 5 conditions because they are by far the most common this time of year and they are highly contagious. There is just no way around it. Okay, so having thrown all that at you, what can you do to help minimize and contain these nasty viruses?

1. Frequent hand washing is the number one way to help prevent the spread of these bugs. Encourage and teach your child to wash their hands several times throughout the day. Before eating, after using the potty, after playing outside, etc. Have them sing a song while washing to make sure they wash long enough (ABC song is a good one).
2. Carry sanitizer. I always wipe my kids’ hands as soon as they get into the car from school. This time of year, it’s just a good habit. Wipe down shopping cart handles too.
3. Encourage children to sneeze and cough into their arms or a tissue.
4. Keep children home if they have a fever, are vomiting, or have significant diarrhea. Of special note: keep them home if they have eye drainage, this could signify a conjunctivitis and should be evaluated by a doctor.
5. Teach them not to share drinking cups or utensils with their friends.
6. By all means, sanitize the toys and personal items in your house after a bout with any of the above.
7. Make sure your children get enough sleep, eat well balanced meals, and exercise regularly. All of these will help insure that their immune systems stay in tip top shape.

Treatment: Since the above, with the exception of strep throat, are caused by viruses, antibiotics will not help. Keep your child comfortable by treating their fever with a fever reducer. Give plenty of fluids and rest. With the stomach flu, keep your child’s diet bland and make sure they stay hydrated with small and frequent amounts of liquids.

Possible Complications: Secondary infections can set in following colds or the flu. Ear infections and pneumonia are common secondary infections. Watch for fever recurrence, chest pain, difficulty breathing, or worsening cough. Dehydration can set in following a bout of gastroenteritis. Stay on top of your child’s liquid intake. These conditions should be evaluated by your child’s pediatrician.

Do not hesitate to contact your child’s pediatrician whenever you’re concerned or have questions regarding your child’s health.

Good Luck to all of you this Fall and Winter season. Unfortunately, these bugs will make their way into our households just make sure your child gets plenty of rest, fluids, and love.

We’ve already battled a short bout of gastroenteritis and a nagging cold. How about you? Have your children been afflicted by any of these back to school bugs yet?

Dr. Arca is a pediatrician. She works part-time while raising her two young children, Big Brother (age 6) and Little Sister (age 3). She is passionate about writing and writing about motherhood, parenting, and children’s health is what she does best. Dr. Arca blogs regularly at Confessions of a Dr. Mom

26 Things I've Learned From My Children

Found this on the web today... I thought it was pretty funny. So I decided to repost it. As far as I can tell, this was originally posted by an anonymous Mother in Austin, Texas.

1. A king-sized waterbed holds enough water to fill a 2000 sq. ft. house 4 inches deep.
2. If you spray hair spray on dust bunnies and run over them with roller blades, they can ignite.
3. A 3-year old's voice is louder than 200 adults in a crowded restaurant.
4. If you hook a dog leash over a ceiling fan, the motor is not strong enough to rotate a 42 pound boy wearing Batman underwear and a Superman cape. It is strong enough, however, if tied to a paint can, to spread paint on all four walls of a 20 x 20 ft. room.
5. You should not throw baseballs up when the ceiling fan is on.
6. When using a ceiling fan as a bat, you have to throw the ball up a few times before you get a hit.
7. A ceiling fan can hit a baseball a long way. (a wiffle ball still does enough damage)
8. The glass in windows (even double-pane) doesn't stop a baseball hit by a ceiling fan.
9. When you hear the toilet flush and the words "uh oh," it's already too late.
10. Brake fluid mixed with Clorox makes smoke, and lots of it.
11. A six-year old can start a fire with a flint rock even though 36-year-old man says they can only do it in the movies.
12. Certain Lego's will pass through the digestive tract of a 4-year old.
13. Play Dough and microwave should not be used in the same sentence.
14. Super glue is forever.
15. No matter how much Jell-O you put in a swimming pool you still can't walk on water.
16. Pool filters do not like Jell-O.
17. VCR's do not eject PB&J sandwiches even though TV commercials show they do.
18. Garbage bags do not make good parachutes.
19. Marbles in gas tanks make lots of noise when driving.
20. You probably do not want to know what that odor is.
21. Always look in the oven before you turn it on. Plastic toys and ovens are a bad combination.
22. The fire department has a 5-minute response time.
23. The spin cycle on the washing machine does not make earthworms dizzy.
24. It will, however, make cats dizzy.
25. Cats throw up twice their body weight when dizzy. (Very True)
26. The mind of a 6-year old is wonderful. First grade...true story.

P.S. 25.6% of the men who read this will try mixing the Clorox and brake fluid