GRADESCHOOL: Friend or Foe?

Help your child navigate his social world by equipping him with the skills he needs to choose friends wisely.

I came to the realization this past year that the days of handpicking my son’s friends are officially over. As a kindergartner, Christian spent the better part of each weekday with 16 other kids, 14 of whom I had never met.

Being a high-energy kid himself, Christian was drawn to the other high-energy kids in class, some of whom didn’t always choose the best way to express that energy. After watching these little guys in action, I found myself wondering what I could do to help Christian choose some other friends that would bring out the best in him, rather than the worst. By reading up on the subject, discussing it with my pediatrician, and talking with parents who’ve already navigated these waters before, I’ve discovered there are some ways parents can help encourage healthier relationships in their children’s lives.

Educate

The best advice I received was to approach teaching Christian how to recognize a good friend, just as I would teach him about bike safety or stranger danger or any other important subject dealing with his health, safety, and well being. At 6, Christian is just beginning to learn how to build a relationship. The more I can guide him in this process, the better off he’ll be. Talk with your child often about how friends should treat one another. Explain that good friends respect others, follow the rules, and help those in need. The more children know about what makes a good friend, the easier it will be for them to recognize one when they meet that child — and to be one himself.

Emulate

As you strive to teach your child about healthy friendships, don’t forget to model them in your own life. Demonstrating good relationships skills with your spouse or partner, and taking time to nurture close friendships with others, is as important as simply talking about these skills if not more so.

“Children learn how to relate to people outside of their family from relationships within the family,” explains Ed Schor, M.D., FAAP, and editor of Caring for Your School-Age Child, Ages 5 to 12. “One would hope that the parents would be friends and would get along well, compromise, etc. Children learn from those exchanges.”

Communicate

While it’s important to talk about what makes a good friend, it’s also good to identify which behaviors are not welcome. Do not focus on specific children and why they are “bad” and others are “good.” Instead, explain the values that you live by in your home, such as positive language, respect for others, sharing, and fair play. It could be as simple as saying, “In our house, we have certain rules that we follow. When someone comes to visit and refuses to follow those rules, he is not showing respect, and that makes everyone sad.” You can balance that by saying, “We have so much more fun when we spend time with friends who do follow the rules.”

Facilitate

To encourage healthy relationships, create opportunities for your child to play with kids who you think have a positive influence on her. Set up play dates at your house where you can observe the children playing together, and then encourage repeat dates with the kids that you feel are good role models for your child.

“You ought to play an active role in choosing your children’s friends. Who better to do this than the parents?” notes Schor. “Know your children’s friends, observe what’s going on, and see if they demonstrate the values you desire.”

If possible, choose to live in a neighborhood with high-quality schools. An Ohio State University study found a direct correlation between school quality and the types of kids that adolescents choose as friends. Kids in better schools tend to choose friends with more “prosocial” characteristics, such as good grades, good attendance, and involvement in extracurricular activities.

Relate

Finally, focus on your relationship with your child. The Ohio State study found that teens are more likely to report positive friendships when they have a good relationship with their parents. (A “good relationship” was defined as one in which the child and parents get involved in activities together, talk frequently, and express affection for one another.)

The more involved you are in your child’s life, the more opportunity you have to help your child develop friendships that can stand the test of time.

The Bully Factor

No matter how many good friends your child has, there may still be times when he finds himself the target of a bully. Talk with him about bullying and share these five tips.

  • Walk away: Bullies are generally looking for a reaction from those they target. When they don’t get one, they’re likely to move on.
  • Speak up: If a bully keeps on bullying, stand tall, look him square in the eye, and say in a clear, loud voice, “I don’t like what you’re doing. Please stop it now.”
  • Ask for help: Talk to a trusted adult about the problem. A teacher or parent can help make the situation better.
  • Find good friends: A bully is only one person. Concentrate on making strong friendships with people who make you feel good.
  • Keep having fun: Don’t let a bully stop you from being part of the activities you enjoy.

Source: Healthy Children Magazine, Back to School. The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Disasters and Your Family: Why to Be Prepared

It’s the 15th anniversary of Hurricane Katrina. That was a disaster that none of us will ever forget; the images of people stranded on rooftops and huddled in the Superdome are in our memories forever.

It was an extraordinary disaster, so extraordinary that it’s easy to think: “Nothing like that will ever happen to my family.” But the truth is that disasters do happen. We are in the midst of hurricane season now. There are wildfires blazing in California. There have been tornados and floods in the Midwest. Last winter brought record snowfall to many areas of the country.

Anything can happen!

Nobody likes to think about a disaster happening—but thinking about it is exactly what we need to do. Preparation makes all the difference; it can literally save lives.


Disasters and COVID-19

Just like all of us could be at risk of catching COVID-19, we could all be at risk for some kind of disaster. Fortunately, there are steps we can take to reduce the danger from both of these.

Allow extra time to prepare. COVID-19 may make affect your ability to get supplies if a disaster strikes. You may want to get toilet paper, masks or cloth face coverings​, hand sanitizer, and wipes now, rather than waiting for later.

Keep preventing the spread. Even during a disaster, take steps to ​​protect yourself from COVID-19. If you have to travel or go to a shelter, try to keep at least 6 feet apart from people not in your family. Remember to wear face coverings over your mouth and nose when near other people. Most children over 2 years old also can wear masks safely. Avoid touching your face, and remember to use hand sanitizer or wash your hands. Remind children to do the same.

Children and families can prepare together. Disasters can be scary, but being ready is one way to be less afraid!​


Make a Plan, Build a Kit, Be Informed Graph

Here are some simple and important things you can do with your family:

  • Talk to your children about disasters that might happen—and what they should do.
  • Know where to get reliable news and information about weather and disasters. Arrange a few different ways to receive alerts, such as texts.
  • Teach children the basics about what to do in a fire, such as getting low to avoid smoke or feeling doorknobs for heat before opening them. Have a fire escape plan.
  • If you live in an area affected by hurricanes​, tornadoes, wildfires or earthquakes, talk with children about how to recognize the signs and where they should go.
  • Make sure children know how to call 911 and can give their name and address. Even very young children can learn this.
  • Decide on a person (preferably not a local person who might be affected by the same disaster) that everyone can contact if you are separated.
  • Have a meeting place outside the house where family members can go if you are separated and can’t reach each other.
  • Practice! That is the best way to be sure the information sticks. Have fire drills and drills for other possible disasters where you live. If you have young children, try making it a game—they will be less scared and more willing to practice regularly.
  • Plan for where you would go if you had to evacuate. Some local shelters may have changed because of COVID-19. If you have pets, make sure the place you are going will accept them.
  • If you plan to purchase a generator for extended power outages after disasters, be sure to learn about steps to prevent carbon monoxide poisoning.

Put together a family disaster kit

Having basic supplies is key if there is a disaster. In the heat of the moment, though, you may not have the time, or presence of mind, to gather them. So, do it ahead of time. The American Academy of Pediatrics and the Centers for Disease Control and Prevention have great information on items to pack, but here are some ideas to get you started:

  • A first-aid kit
  • Water (2 gallons per day per person)
  • Flashlights, batteries, chargers
  • A battery-operated radio
  • Non-perishable foods, such as canned foods (include a can opener), granola bars and peanut butter
  • Cups and utensils (you can pick up some inexpensive camping kits)
  • Spare clothes, and a blanket or two
  • Toys or games
  • Supplies for pets
  • Medications—if you can, try to stay ahead of your refills and keep one in the disaster kit. At the very least, take a picture of the bottle so that you know exactly what you take.

Tip: It’s not always possible to keep things like current medications stored away, so make a checklist of everything you might need to grab quickly. You can tape the list to the top of the container, which should be a manageable size (you may need a couple of them) and in a readily accessible place in your house.

Extra supplies to include during the COVID-19 pandemic

  • hand sanitizer with at least 60% alcohol, bar or liquid soap
  • disinfectant wipes (if available)
  • Two masks for each person over age 2​

Involve your children in planning and packing—you can make it a game by doing a scavenger hunt. Remember to check expiration dates and have kids help with remembering and doing that, too. The more you make it something regular and ordinary, the better.

Hopefully, your emergency preparations will never be more than a game. But should a disaster ever hit, they will be the most important game your family ever played.


By Claire McCarthy, MD, FAAP and Scott Needle, MD, FAAP. Source: American Academy of Pediatrics AAP Council on Children and Disasters (Copyright © 2020). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

YOUNG ADULT: Letting Go for College

All animals grow up and leave the nest. They go through their playful phase, practice adulthood, and then are on their own. Human children just play longer and their parents worry more. When children are ready for college, parents want that last time at home to be so special. It’s the last opportunity for family togetherness. It should be a perfect time. The last family vacation before the child leaves home should be idyllic. Why then does your daughter say, “Mom, I hate you. I’d rather be with my friends. It’s a good thing I’m leaving in August because I couldn’t stand one more minute in this prison”?

Because she is ready to cross a chasm, and it’s so much easier than saying, “I love you so much that I can’t even find the right words. You’ve done every thing for me. I’m petrified. Do you think I’m ready to go off on my own? Do you think you’ll miss me as much as I’m going to miss you?”

Adolescents challenge parents because they need to loosen one kind of connection—the one that involves parents’ assuming full responsibility for them. When challenged this way, it’s completely understandable for parents to feel hurt or even angry. If they don’t understand what is happening, parents may push harder to keep control. This only breeds resentment and ill feelings. But if they recognize that their teen is struggling for independence and learn to celebrate it, everyone will be healthier and less tense.

Every time kids behave badly or speak meanly to parents doesn’t necessarily reflect their growing independence or their conflicted emotions. Sometimes they might just be acting mean. They know a parent’s vulnerabilities.

Whether they are justifiably or unfairly angry, they can be masters at saying hurtful things. Often it’s a way of shouting, “Listen to me!” Perhaps they’re testing the waters to grab attention before they can bring up something that’s troubling them. If parents respond with anger and shut them down, they may feel justified for not sharing their concerns: “Remember, I was going to tell you, but then….” When parents listen and reserve judgment, their teenagers’ stories unfold.

But it’s OK to tell them when they hurt your feelings—not in a way that makes them feel guilty, but just a clear statement of fact that their behavior is inappropriate and hurtful. That is an important part of a parent’s job in building character. Even when kids challenge the parental connection, parents need to be consistent about one thing: Their love is unconditional and they will always be there for their children. With this clear message, parents say, “Go ahead—grow. I’ve got your back.”


Source: Less Stress, More Success: A New Approach to Guiding Your Teen Through College Admissions and Beyond (Copyright © 2006 Kenneth R. Ginsburg, MD, MsEd, FAAP Martha M. Jablow and Marilee Jones). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

TEENS: Independence, One Step at a Time

It is an adolescent’s job to gain the confidence to be able to stand on his own. As challenging as it is to watch our children grow up, it is critical to their well-being and to the health of our relationships that we honor their growing independence. When we hold them back they rebel against us. When we monitor their safety while guiding them towards independence – sometimes actively and sometimes by getting out of the way – they appreciate us. When our children know that we supported them to become independent, they will return to us for that interdependence that defines loving families well beyond childhood.

It’s everyday issues, even seemingly mundane ones, that trigger most parent-child struggles and offer opportunities for fostering independence. Your child thinks she should be allowed a new privilege just because she’s a certain age or because her friends are doing it, but she might lack the skills needed to manage the situation. If you focus on preparing your adolescent, you will turn potential sources of conflict and rebellion into opportunities for your child to master new skills and demonstrate responsibility.

Adolescence is naturally filled with opportunities for trial and error and ultimately success. Your challenge is to make sure your adolescent learns from day-to-day mistakes rather than views them as catastrophes. At the same time you need to be vigilant in helping your teen avoid those errors that could cause irreparable harm. Just as importantly, you want to ensure your child doesn’t miss out on the many possibilities for growth that are coming along.

The answer to when your child is ready to meet a new challenge is about recognizing when there are enough pieces in place so the chances for success are enhanced. A request by your 14 year old to spend the afternoon at the mall won’t hinge on answering on the spot “Is she old enough?” if you’ve taught her, in part through your example, about spending wisely and treating clerks with respect. The day your teen begins to drive won’t be so nerve-wracking if you’ve modeled safe driving behaviors and made it clear you will monitor your teen’s progress even after he gets his license.

Sometimes you should start by doing some observing. Think back to when you baby-proofed your home. If you just guessed what needed safeguarding, you might have missed some opportunities to protect your baby. The first step was to walk around on your knees and see the surroundings at the same level as your toddler. Once you saw the world from his vantage point, you knew to turn that pot handle inward. That same sort of observing — getting a “kid’s eye view” of the mall or the route to school — will heighten your senses about the challenges your teen is likely to encounter. You’ll be better positioned to think of how best to phase in new privileges and what kinds of support and monitoring need to be in place to help things go smoothly.

It is important to use a step-by-step approach to allow your child to demonstrate he’s ready to assume more responsibility. A thoughtful step-wise strategy will help both your child and you gain confidence, and will allow you to give a little bit of rope at a time and tighten up again as needed.


Author: Kenneth R. Ginsburg, MD, MS Ed, FAAP. Source, adapted from Letting Go with Love and Confidence: Raising Responsible, Resilient, Self-Sufficient Teens in the 21st Century (Copyright © 2011 Avery). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Mask Mythbusters: 5 Common Misconceptions about Kids & Cloth Face Coverings

Along with physically distancing and good hand washing, masks or cloth face coverings are an effective way to help prevent the spread of COVID-19. Some parents may have questions and concerns about cloth face coverings, and we’re here to help.

Here are 5 common questions about kids and masks, along with evidence-based information that will put your mind at ease:

1. Can wearing a mask make it harder​ for my child to breathe?

There have been concerns that cloth face coverings can reduce oxygen intake, and can lead to low blood oxygen levels, known as hypoxemia. However, cloth masks are made from breathable materials that will not block the oxygen your child needs. Masks will not affect your child’s ability to focus or learn in school. The vast majority of children age 2 or older can safely wear a cloth face covering for extended periods of time, such as the school day or at child care. This includes children with many medical conditions.

2. Can masks interfere with a child’s lun​​g development?

No, wearing a cloth face covering will not affect your child’s lungs from developing normally. This is because oxygen flows through and around the mask, while blocking the spray of spit and respiratory droplets that may contain the virus. Keeping your child’s lungs healthy is important, which includes preventing infections like COVID-19.

3. Do masks trap the carbon dioxide ​that we normally breathe out?

No. There have been false reports that cloth face coverings can lead to carbon dioxide poisoning (known as hypercapnia) from re-breathing the air we normally breathe out. But this is not true. Carbon dioxide molecules are very tiny, even smaller than respiratory droplets. They cannot be trapped by breathable materials like cloth masks. In fact, surgeons wear tight fitting masks all day as part of their jobs, without any harm.

However, children under 2 years of age should not wear masks since they may not be able to remove them without help. Children with severe breathing problems or cognitive impairments may also have a hard time tolerating a face mask and extra precautions may be needed.

4. Can masks lead to a weaker immune​ system by putting the body under stress?

No. Wearing a cloth face covering does not weaken your immune system or increase your chances of getting sick if exposed to the COVID-19 virus. Wearing a cloth face covering, even if you do not have symptoms of COVID-19, helps prevent the virus from spreading.

5. How do masks prevent the ​​spread of COVID-19?

When worn correctly, cloth masks create a barrier that reduces the spray of a person’s spit and respiratory droplets. These droplets play a key role in the spread of COVID-19 because they can carry SARS-CoV-2, the virus that causes COVID-19. Masks also can protect you from others who may have coronavirus but are not showing symptoms and who could come within 6 feet of you, which is how far respiratory droplets can travel when people sneeze or cough or raise their voices.

In order to be effective, masks should:

  • Cover both the nose and mouth​​
  • Fit snugly but comfortably against the sides of the face
  • Be secured with ear loops or ties
  • Have multiple layers of fabric
  • Allow for unrestricted breathing
  • ​Be washed and dried carefully after use​

Another benefit of wearing masks is that they may keep people from touching their mouths and faces, which is another way COVID-19 can be spread. There are many types of masks, but cloths masks are best choice for the general public and families should choose a mask that is most comfortable while still providing a secure fit.

Remem​​ber

Cloth face coverings are an important tool in preventing the spread of COVID-19. They are safe and effective for children over the age of 2 years and adults. Cloth face coverings are especially important when social distancing, or keeping 6 feet away from others, is hard to do. Washing hands, staying home and physical distancing are still the best ways to keep your family safe from COVID-19. But when you go outside your home, wearing a cloth face covering will help keep you and others safe.

Don’t hesitate to talk with your child’s pediatrician if you have any questions about your child wearing cloth face coverings.


Image courtesy of the CDC. Article written by Kimberly W. Dickinson, MD, MPH, is a pediatric pulmonary fellow at Johns Hopkins University in Baltimore, MD and a member of the AAP Section on Pediatric Pulmonology and Sleep Medicine Trainee Subcommittee; and Theresa W. Guilbert, MD, MS, FAAP, is a Professor of Pediatrics at the University of Cincinnati and the Director of the Cincinnati Children’s Hospital Medical Center Asthma Center in the Pulmonary Division. She has 20 years of experience in providing clinical care to children and adolescents with preschool, childhood and severe asthma and conducting clinical and epidemiologic research. She is a member of the AAP Section on Pediatric Pulmonology and Sleep Medicine Committee. Source American Academy of Pediatrics Section on Pulmonary and Sleep Medicine (Copyright © 2020). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Return to School During COVID-19

​​​​​​​With the start of a new school year, a lot needs to happen so that students can learn and thrive without raising the risk of spreading COVID-19.

The goal of having children attend school in person–which is how they learn best — will only be safe when a community has the spread of the virus under control.  And then, when it is possible to reopen a school for in-person learning, a layered approach is needed to keep students, teachers and staff safe.

Why students should go back to school–when it is safe

​Schools provide more than just academics to children and adolescents. In addition to reading, writing and math, students learn social and emotional skills, get exercise, and have access to mental health support and other services that cannot be provided with online learning. For many children and adolescents,  schools are safe places to be while parents or guardians are working.  For many families, schools are where kids get healthy meals, access to the internet and other vital services.

​The pandemic has been especially hard for Black, Latinx, Native American/Alaska native children and adolescents, and those living in low-income families.  One in 5 teens cannot complete schoolwork at home because they do not have a computer or internet connection.

But whatever form learning takes, the AAP ​advises that schools need funding to provide safety measures for in-person learning and to be able to support all students in virtual learning plans.

WHAT SCHOOLS CAN DO

To stay safe, there are a number of steps schools should take to help prevent the spread of COVID-19. They include:

Physical distancing. The goal for students and adults is to stay at least 6 feet apart to help prevent the spread of the virus. However, research has found that spacing desks at least 3 feet apart and avoiding close contact may have similar benefits — especially if students wear cloth face coverings and do not have symptoms of illness. Teachers and staff should stay 6 feet apart from other adults and from students when possible. Teachers and staff should also wear cloth face coverings, limit in-person meetings with other adults and avoid areas such as staff lounges.

When possible, schools should use outdoor spaces and unused spaces for instruction and meals to help with distancing. For example, activities like singing, band and exercising are safest outdoors and spread out.

Cloth face coverings & hand hygiene. All children over age 2 years and all adults should wear cloth face coverings that cover the nose and mouth to stop the spread of the virus.  When worn correctly, cloth face coverings are  safe to wear for long periods of time such as during the school day.  In addition, frequent hand washing with soap and water is important for everyone.

Classroom changes. To help limit student interaction outside the classroom, schools should consider:

  • Having teachers move between classrooms, rather than having students fill the hallways during passing periods.
  • Allowing students to eat lunches at their desks or in small groups outdoors instead of in crowded lunchrooms.
  • Leaving classroom doors open to help reduce high touch surfaces such as doorknobs.

Testing & temperature checks. The CDC currently does not recommend COVID testing of students and staff​. Testing only shows whether a person is infected at that specific moment in time and may not be useful in preventing outbreaks in school communities.  Taking students’ temperatures at school may also not be feasible, but you can monitor your children’s health at home and keep them home if they are not feeling well. Schools should frequently remind students, teachers, and staff to stay home if they have a fever of 100.4 degrees F or greater or have any signs of illness.

Exposure.  While current evidence suggests that children younger that 10 years may be less likely to become infected with SARS-CoV-2, and less likely to spread the infection to others, schools still need to plan for exposures.  If a student of staff member has close contact with someone known to have SARS-CoV-2 infection, they should quarantine for 14 days from the day they were in close contact.  Close contact means being within 6 feet of the person for at least 15 minutes.  A person is known to be infected if they have a laboratory-confirmed infection or illness consistent with COVID-19.

Symptoms at school. School nurses will take the temperature of anyone who feels ill during the school day, and there should be a specific area to separate or isolate students who are not feeling well. To stay safe, school nurses should use PPE (personal protective equipment) such as N95 masks, surgical masks, gloves, disposable gowns and face shields.

Cleaning and disinfecting. Schools should follow CDC guidelines on proper disinfecting and sanitizing classrooms and common areas.

Buses, hallways and playgrounds

Since these are often crowded spaces, schools can:

  • Give bus riders assigned seats and require them to wear a cloth face coverings while on the bus.
  • Encourage students who have other ways to get to school to use those options.
  • At school, mark hallways and stairs with one-way arrows on the floor to cut down on crowding in the halls. Assign lockers by group or eliminate use of lockers.
  • Encourage outdoor activities such as using the playground in small groups. Playground equipment should be included in cleaning plans.

Other considerations

In addition to having plans in place to keep students safe, there are other factors that school communities need to address:

Students at higher risk. While COVID-19 school policies can reduce risk, they will not prevent it.  Some students with high-risk medical conditions​ may need other accommodations. Talk with your pediatrician and school staff (including school nurses) to see if your child needs additional solutions to help ensure safety at school.

Students with disabilities. The impact of schools being closed may have been greater for students with disabilities. They may have a difficult time transitioning back to school after missing out on instruction time as well as school-based services such as occupational, physical and speech-language therapy and mental health support counseling. School should review the needs of each child with an Individual Education Program before they return to school, and providing services even if they are done virtually.

Immunizations & well-child exams. It is important as students return to school that they are up to date on their immunizations. It will be critical that students and staff get their flu shot this year to reduce the spread of influenza this fall and winter.

Screenings. ​Vision and hearing screening should continue in schools, when possible. These services help identify children in need of treatment as soon as possible and prevent interferences with learning.

Behavioral health/emotional support. Your child’s school should anticipate and be prepared to address a wide range of mental health needs of students and staff. This includes providing mental health support for any student struggling with stress from the pandemic and recognizing students who show signs of anxiety or distress. Schools also can help students with suicidal thoughts or behavior get needed support.​

Nutrition. Many students receive healthy meals through school meal programs. More students might be eligible for free or reduced meals than before the pandemic. Schools should provide meal programs even if the school closes or the student is sick and stays home from school.

​Remember

Returning to school during the COVID-19 pandemic may not feel like normal – at least for a while. But whatever form school takes, it will require everyone’s support to make sure that it is healthy, safe and equitable for students, teachers, staff and families.​


Source: American Academy of Pediatrics (Copyright © 2020). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

What’s the Best Way to Discipline My Child?

As a parent, one of your jobs to teach your child to behave. It’s a job that takes time and patience. But, it helps to learn the effective and healthy discipline strategies.

Here are some tips from the American Academy of Pediatrics (AAP) on the best ways to help your child learn acceptable behavior as they grow. 

10 Healthy Discipline Strategies That Work

The AAP recommends positive discipline strategies that effectively teach children to manage their behavior and keep them from harm while promoting healthy development. These include:

  1. Show and tell. Teach children right from wrong with calm words and actions. Model behaviors you would like to see in your children.
  2. Set limits. Have clear and consistent rules your children can follow. Be sure to explain these rules in age-appropriate terms they can understand.
  3. Give consequences. Calmly and firmly explain the consequences if they don’t behave. For example, tell her that if she does not pick up her toys, you will put them away for the rest of the day. Be prepared to follow through right away. Don’t give in by giving them back after a few minutes. But remember, never take away something your child truly needs, such as a meal.
  4. Hear them out. Listening is important. Let your child finish the story before helping solve the problem. Watch for times when misbehavior has a pattern, like if your child is feeling jealous. Talk with your child about this rather than just giving consequences.
  5. Give them your attention. The most powerful tool for effective discipline is attention—to reinforce good behaviors and discourage others. Remember, all children want their parent’s attention.
  6. Catch them being good. Children need to know when they do something bad–and when they do something good. Notice good behavior and point it out, praising success and good tries. Be specific (for example, “Wow, you did a good job putting that toy away!”).
  7. Know when not to respond. As long as your child isn’t doing something dangerous and gets plenty of attention for good behavior, ignoring bad behavior can be an effective way of stopping it. Ignoring bad behavior can also teach children natural consequences of their actions. For example, if your child keeps dropping her cookies on purpose, she will soon have no more cookies left to eat. If she throws and breaks her toy, she will not be able to play with it. It will not be long before she learns not to drop her cookies and to play carefully with her toys.
  8. Be prepared for trouble. Plan ahead for situations when your child might have trouble behaving. Prepare them for upcoming activities and how you want them to behave.
  9. Redirect bad behavior. Sometimes children misbehave because they are bored or don’t know any better. Find something else for your child to do.
  10. Call a time-out. A time-out can be especially useful when a specific rule is broken. This discipline tool works best by warning children they will get a time out if they don’t stop, reminding them what they did wrong in as few words―and with as little emotion―as possible, and removing them from the situation for a pre-set length of time (1 minute per year of age is a good rule of thumb). With children who are at least 3 years old, you can try letting their children lead their own time-out instead of setting a timer. You can just say, “Go to time out and come back when you feel ready and in control.” This strategy, which can help the child learn and practice self-management skills, also works well for older children and teens.

Fat, Salt and Sugar: Not All Bad

Forcing children to eat food doesn’t work. Neither does forbidding foods. When children think that a food is forbidden by their parents, the food often becomes more desirable.

It’s important for both children and adults to be sensible and enjoy all foods and beverages, but not to overdo it on any one type of food. Sweets and higher-fat snack foods in appropriate portions are OK in moderation.

The following is information about fat, sugar, and salt and dietary recommendations based on recommendations from the US Department of Agriculture and the US Department of Health and Human Services.

Encouraging Healthy Eating for a Healthy Heart

Childhood is the best time to start heart healthy eating habits, but adult goals for cutting back on total fat, saturated fat, trans fat, and cholesterol are not meant generally for children younger than 2 years.

Fat is an Essential Nutritent for Children. Fat supplies the energy, or calories, children need for growth and active play and should not be severely restricted.

Dangers of High Fat Intake. However, high fat intake—particularly a diet high in saturated fats—can cause health problems, including heart disease later in life. Saturated fats are usually solid at room temperatures and are found in fatty meats (such as beef, pork, ham, veal, and lamb) and many dairy products (whole milk, cheese, and ice cream).

For that reason, after age 2 children should be served foods that are lower in fat and saturated fats.

Healthier, More Low-Fat, Low-Cholesterol Foods for Children Over Age 2:

  • Poultry
  • Fish
  • Lean meat (broiled, baked, or roasted; not fried)
  • Soft margarine (instead of butter)
  • Low-fat dairy products
  • Low-saturated fat oils from vegetables
  • Limiting egg consumption

The General Rule on Fats

As a general guideline, fats should make up less than 30% of the calories in your child’s diet, with no more than about one-third or fewer of those fat calories coming from saturated fat and the remainder from unsaturated (polyunsaturated or monounsaturated) fats, which are liquid at room temperature and include vegetable oils like corn, safflower, sunflower, soybean, and olive.

Some parents find the information about various types of fat confusing. In general, oils and fats derived from animal origin are saturated. The simplest place to start is merely to reduce the amount of fatty foods of all types in your family’s diet.

Note: Whole milk is recommended for children 12 to 24 months of age. However, you child’s doctor may recommend reduced-fat (2%) milk if your child is obese or overweight or if there is a family history of high cholesterol or heart disease. Check with your child’s doctor or dietition before switching from whole to reduced-fat milk.

Serve Children Foods Low in Salt

Table salt, or sodium chloride, may improve the taste of certain foods. However, researchers have found a relationship between dietary salt and high blood pressure in some individuals and population groups. High blood pressure afflicts about 25% of adult Americans and contributes to heart attacks and strokes.

Take the Salt Shaker Off the Table. The habit of using extra salt is an acquired one. Thus, as much as possible, serve your child foods low in salt. In the kitchen, minimize the amount of salt you add to food during its preparation, using herbs, spices, or lemon juice instead. Also, take the salt shaker off the dinner table, or at least limit its use by your family.

Check Sodium Levels in Processed Foods. Processed foods often contain higher amounts of sodium. Check food labels for levels of sodium in:

  • Processed cheese
  • Instant puddings
  • Canned vegetables
  • Canned soups
  • Hot dogs
  • Cottage cheese
  • Salad dressings
  • Pickles
  • Certain breakfast cereals
  • Potato chips and other snacks

Sugar in Your Child’s Diet: More Than Just a Sweetener

Caloric sweeteners range from simple sugars, like fructose and glucose, to common table sugar, molasses, honey, and high fructose corn syrup. Although the main use of sugar is as a sweetener, sugar has other uses. For example, sugar can be used as a preservative, can change the texture of foods, and can enhance flavors and add color.

Sugar Supplies Energy. Sugars in foods, whether natural or added, provide calories—the fuel that supplies energy necessary for daily activities. And if given the choice, many children would probably request sugary foods and beverages for breakfast, lunch, and dinner—research shows that humans are naturally drawn to sweet tastes.

Too Much Sugar Means Too Many Calories. Parents should keep in mind that calories from sugar can quickly add up and over time can lead to weight gain, and sugar also can play a role in the development of tooth decay.


Source: Healthy Children, Fit Children: Answers to Common Questions From Parents About Nutrition and Fitness (Copyright © 2011 American Academy of Pediatrics). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Backyard Pool Safety

Swimming pools can have a powerful pull on little children―even when it’s not swimming time. Those glistening turquoise-blue ripples may look especially inviting to an active toddler or an overly confident preschooler.

Kids can slip away from the watchful eyes of adults in seconds. It happens every day.

The American Academy of Pediatrics (AAP) recommends several ways parents can help keep children safe around home swimming pools and hot tubs―all year long―in your own backyard, your neighbor’s, or on vacation.

Fact: Most drownings in kids 4 and under happen in home swimming pools.

The U.S. Consumer Product Safety Commission (CPSC) studied drownings among children age 4 and under in Arizona, California, and Florida, where pools are especially common. It found that nearly 70% of the children were not expected to be at or in the pool, yet they were found in the water. In fact, 46% of the children were last seen in the house.

Pool fences. Safety precautions not ​to ignore.

Pool fences are for above-ground pools that are portable as well as those that are permanent, in-ground pools, and hot tubs.

Between 2013 and 2015, most (58%) drownings among children age 4 and under took place in a pool or spa at their own home. Most children drowned when they wander out of the house and fell into a swimming pool that was not fenced off from the house. They slipped out a door, climbed out a window, or even crawled through a doggy door to access the pool.

But, a family swimming pool isn’t the only one a child can get into unnoticed. More than a quarter (27%) of drownings among children age 4 and under took place at the home of a friend, relative or neighbor. Only some individual states and municipalities have laws requiring pool safety fences; there is no national pool fence law. Whenever your child will be in someone else’s home, always check for ways your child could access pools and other potential hazards.

Fact: Fences are the most effective, proven way to prevent drowning of young children.

Pool Fencing Recommendations:

  • 4 feet, 4 sides. The pool fence should be at least 4 feet high and completely surround the pool, separating it from the house and the rest of the yard.
  • Climb-proof. The fence shouldn’t have any footholds, handholds, or objects such as lawn furniture or play equipment the child could use to climb over the fence. Chain-link fences are very easy to climb and are not recommended as pool fences. (If they are used, make sure openings are 1¾ inches or smaller in size).
  • Slat space. To ensure a small child can’t squeeze through the fence, make sure vertical slats have no more than 4 inches of space between them. This will also help keep small pets safe, too.
  • Latch height. The fence should have a self-closing and self-latching gate that only opens out, away from the pool area. The latch should be out of a child’s reach—at least 54 inches from the ground.
  • Gate locked, toy-free. When the pool is not in use, make sure the gate is locked. Keep toys out of the pool area when it is not in use.

Alarms. A child drowning is rarely heard.

Beyond a fence, additional layers of protection such as pool alarms, door and gate alarms, and pool covers can provide some added safety around a pool. Make sure alarms are in good shape with fresh batteries, and keep in mind none are substitutes for a properly installed pool fence.

Drowning is silent. Alarms break that silence.

  • Pool alarms. Children can drown within seconds, with barely a splash. Swimming pool alarms can detect waves on the water’s surface and sound off to attract attention when someone has fallen into the pool.
  • Consider alarms on the pool fence gate and house doors. Door and gate alarms can be equipped with touchpads to let adults pass through without setting them off. House doors should be locked if a child could get to the pool through them.
  • Window guards. These can be especially helpful for windows on the house that face the pool.

A word on pool covers:

Pool covers should cover the entire pool securely enough that a child can’t slip under them. Make sure no standing water collects on top—children can drown in less than 2 inches of water. Power-operated covers are often the safest and easiest to use. Remember: Floating solar and winter covers are not safety covers and can actually increase drowning risk. Because a floating cover makes the pool surface appear solid, a small child might try to retrieve a ball or other light toy that landed on it and quickly slip underneath—often trapped and hidden from view. ​

What Else Can Parents Do?

Even with safety measures in place, parents should be prepared in case that their child gets into a swimming pool unseen.

Some precautions that may help:

  • Assign a water watcher. His or her job is to watch all children swimming or playing in or NEAR water―such as on a backyard swing set―even if they know how to swim. This person should:
    • not be under the influence of drugs or alcohol
    • put down his or her cell phone
    • avoid other activities
    • supervise even if there are lifeguards
    • switch off with another adult for breaks
  • Life jackets: Put your child in a properly fitted US Coast Guard approved life jacket when around or near water, such as when visiting a home with a pool.
  • Swim lessons. The AAP recommends swim lessons as a layer of protection against drowning that can begin for many children starting at age 1.
  • CPR training. Parents, caregivers, and pool owners should know CPR and how to get emergency help. Keep equipment approved by the U.S. Coast Guard, such as life preservers and life jackets at poolside.
  • Check the water first. If a child is missing, look for him or her in the pool or spa first. This is especially important if your child is prone to wandering.

Last Updated: 7/13/2020. Source: American Academy of Pediatrics (Copyright © 2019). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.


Hand Sanitizers: Keep Children Safe from Poisoning Risk

​​​​​Washing hands with soap and clean water for at least 20 seconds is the best way for children to get rid of germs, including COVID-19. If soap and water are not available, they can use hand sanitizer with at least 60% alcohol.

However, swallowing just a tiny amount of hand sanitizer can cause poisoning in children. Many hand sanitizers are made with alcohol or rubbing alcohol (ethanol, ethyl alcohol, or isopropanol, isopropyl alcohol). Alcohol poisoning symptoms include sleepiness, low blood sugar, seizures and coma, and it can be fatal.

Children and adults also have been poisoned after using hand sanitizer that contained methanol (also called wood alcohol, methyl alcohol, or methylated spirits). It should not be used in hand sanitizer, and these products were recently recalled. Methanol is toxic if swallowed or after repeated use on skin. It may cause nausea, vomiting, headache, blurred vision, blindness, seizures, coma, permanent damage to the nervous system, or death.

The American Academy of Pediatrics urges parents to keep hand sanitizers out of children’s reach. Don’t forget about travel-size bottles of sanitizer in purses, diaper bags, backpacks and cars. Parents and caregivers also should supervise children ages 5 and younger when they use hand sanitizer.

Hand sanitizer & COVI​​D-19
As families began buying more hand sanitizer during the COVID-19 pandemic, the National Poison Data System started getting more reports of unintentional exposures in children. In the first half of 2020, there have been 46% more reported cases about hand sanitizer than during the same time last year. Many reports were about children ages 5 years and younger.

Health experts recommend using hand sanitizer that is 60% to 95% alcohol to kill the virus that causes COVID-19. Drinking alcohol typically has 5% to 40% alcohol.

Check th​​e label
The Food and Drug Administration (FDA) began letting companies that do not normally produce hand sanitizer make and sell it during the COVID-19 pandemic. When buying hand sanitizer, parents should make sure it has a label that lists the ingredients, warnings and precautions.

To reduce the risk of injury from children drinking hand sanitizers, producers should add ingredients to make them taste bitter. This important step helps prevent children from eating the product. However, the FDA has been alerted that some young people have tried drinking hand sanitizers from distilleries that have not taken the step to make them taste bad.

To help make sure the sanitizer’s taste will not appeal to children, look for the word “denatured” on the bottle. You can also check for bitter ingredients such as denatonium benzoate (Bitrex); sucrose octaacetate; or butanol (also called tert-butyl alcohol).

Some products are made with isopropyl alcohol (isopropanol). Be especially careful with these sanitizers around children, since they can be more toxic than those made with ethanol or ethyl alcohol.

A word about homemade​​ hand sanitizers
​With some shortages of hand sanitizers during the COVID-19 crisis, it may be tempting to make your own hand sanitizer. However, this may not be the best option. The FDA warns that if made incorrectly, hand sanitizer may not work. There have also been reports of skin burns from homemade hand sanitizer.

Disposing of ​recalled products
Do not flush or pour recalled hand sanitizers down the drain. These products should be disposed of in hazardous waste containers, if possible. If unsure, check with your local waste management and recycling center.

Remem​​ber…
Call 911 right away if your child has collapsed, is having a seizure, is having a hard time breathing, or if they can’t wake up after using or swallowing hand sanitizer products. If you have questions about hand sanitizer product safety, call your regional poison control center at 1-800-222-1222 or visit WebPoisonControl.


Source: AAP Council on Injury, Violence and Poison Prevention (Copyright © 2020). The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.